Organization
STC PEDIATRICS LLC
Active
Other names
St. Christopher's Pediatric Associates General Surgery - E. Erie Ave
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN RAYME (EVP & CFO)
(484) 628-1324
Entity
Organization
Contact information
Practice address
160 E ERIE AVE, PHILADELPHIA, PA 19134-1011
(215) 427-5292
Mailing address
PO BOX 13579, READING, PA 19612-3579
Taxonomy
Speciality
Code
Description
License number
State
1223S0112X
Oral and Maxillofacial Surgery (Dentist)
—
—
204E00000X
Oral & Maxillofacial Surgery (D.M.D.)
—
—
208000000X
Pediatrics Physician
—
—
2086S0120X
Pediatric Surgery Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1037317900011
—
PA
Enumeration date
10/31/2019
Last updated
11/06/2025
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