1518371756 NPI number — STEPHANIE TANNER WALSH M.D.

Table of content: STEPHANIE TANNER WALSH M.D. (NPI 1518371756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518371756 NPI number — STEPHANIE TANNER WALSH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WALSH
Provider First Name:
STEPHANIE
Provider Middle Name:
TANNER
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TANNER
Provider Other First Name:
STEPHANIE
Provider Other Middle Name:
LEIGH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1518371756
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 MEDICAL CENTER BLVD OFC
Provider Second Line Business Mailing Address:
3 EAST RESIDENCY OFFICE
Provider Business Mailing Address City Name:
CHESTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19013-3902
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-447-6682
Provider Business Mailing Address Fax Number:
610-447-6677

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
POB1, SUITE 205, CROZER PEDIATRICS
Provider Business Practice Location Address City Name:
CHESTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19013-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-619-7410
Provider Business Practice Location Address Fax Number:
610-876-8483
Provider Enumeration Date:
06/16/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  25MA10143800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: C1-0012210 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: MD462124 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)