Individual
STEPHANIE FULLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
34TH & CIVIC CENTER BLVD, CHILDREN'S HOSPITAL OF PHILADELPHIA, PHILADELPHIA, PA 19104-4399
(215) 590-2708
(215) 590-2715
Mailing address
6201 GREENLEIGH AVE, MIDDLE RIVER, MD 21220-2004
(410) 955-5000
(410) 500-4266
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD420734
PA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
Primary
D0105511
MD
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
MD420734
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100743887-0030
—
PA
Enumeration date
07/03/2007
Last updated
12/09/2025
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