Basic Information
| Provider Information | |||||||||
| NPI: | 1518371756 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WALSH | ||||||||
| FirstName: | STEPHANIE | ||||||||
| MiddleName: | TANNER | ||||||||
| NamePrefix: | |||||||||
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| Credential: | M.D. | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | TANNER | ||||||||
| OtherFirstName: | STEPHANIE | ||||||||
| OtherMiddleName: | LEIGH | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 1 MEDICAL CENTER BLVD OFC | ||||||||
| Address2: | 3 EAST RESIDENCY OFFICE | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133902 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6104476682 | ||||||||
| FaxNumber: | 6104476677 | ||||||||
| Practice Location | |||||||||
| Address1: | 30 MEDICAL CENTER BLVD | ||||||||
| Address2: | POB1, SUITE 205, CROZER PEDIATRICS | ||||||||
| City: | CHESTER | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190133955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6106197410 | ||||||||
| FaxNumber: | 6108768483 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/16/2014 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 25MA10143800 | NJ | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | C1-0012210 | DE | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | MD462124 | PA | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.