Individual
STEPHANIE BLACK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
34TH STREET & CIVIC CENTER BLVD, SUITE 9329, PHILADELPHIA, PA 19104-4399
(215) 590-1858
(215) 590-1415
Mailing address
100 E PENN SQ, PHILADELPHIA, PA 19107-3323
(267) 425-9300
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
38050
NH
207LP3000X
Pediatric Anesthesiology Physician
Primary
MD443506
PA
208000000X
Pediatrics Physician
MT191494
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1027597410001
—
PA
01
—
254874EJL
MEDICARE PTAN
PA
Enumeration date
06/29/2007
Last updated
09/03/2025
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