Basic Information
| Provider Information | |||||||||
| NPI: | 1871561969 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BARBETTA | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | |||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 829641 | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191821302 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2673705296 | ||||||||
| FaxNumber: | 2152303725 | ||||||||
| Practice Location | |||||||||
| Address1: | 3401 N BROAD STREET | ||||||||
| Address2: | |||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 19140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157075030 | ||||||||
| FaxNumber: | 2157073494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/14/2006 | ||||||||
| LastUpdateDate: | 04/09/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/09/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD418923 | PA | N | Allopathic & Osteopathic Physicians | Family Medicine | 207P00000X | MD418923 | PA | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1009106900001 | 05 | PA | MEDICAID |