Organization
STANFORD PEDIATRIC SURGERY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ALA STANFORD MD (FOUNDER/DIRECTOR)
(215) 817-8683
Entity
Organization
Contact information
Practice address
419 JOHNSON ST, JENKINTOWN, PA 19046-2705
(215) 792-2058
(215) 754-4295
Mailing address
ARCHWAYS PROFESSIONAL BUILDING, 419 JOHNSON STREET, JENKINTOWN, PA 19046-2705
(215) 792-2058
(215) 754-4295
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
MD419738
PA
2086S0120X
Pediatric Surgery Physician
Primary
MD419738
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1750394037
NPI
PA
Enumeration date
08/18/2017
Last updated
07/21/2022
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