| Stephanie Fuller, MD | |
| 34th & Civic Center Blvd, Children's Hospital Of Philadelphia, Philadelphia, PA 19104-4399 | |
| (215) 590-2708 | |
| (215) 590-2715 | 
| Full Name | Stephanie Fuller | 
|---|---|
| Gender | Female | 
| Speciality | Thoracic Surgery (cardiothoracic Vascular Surgery) | 
| Location | 34th & Civic Center Blvd, Philadelphia, Pennsylvania | 
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. | 
| Identifier | Type | State | Issuer | 
|---|---|---|---|
| 1013115930 | NPI | - | NPPES | 
| 100743887-0030 | Medicaid | PA | 
| Taxonomy | Type | License (State) | Status | 
|---|---|---|---|
| 208600000X | Surgery | MD420734 (Pennsylvania) | Secondary | 
| 208G00000X | Thoracic Surgery (cardiothoracic Vascular Surgery) | MD420734 (Pennsylvania) | Primary | 
| Entity Name | Children's Surgical Associates Ltd | 
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice | 
| Entity Identifiers | NPI Number: 1326117185 PECOS PAC ID: 9739083494 Enrollment ID: O20040209000124 | 
| Mailing Address | Practice Location Address | 
|---|---|
| Stephanie Fuller, MD 100 East Penn Square, The Wanamaker Building 9th Fl, Philadelphia, PA 19107-3323 Ph: (267) 425-9538 | Stephanie Fuller, MD 34th & Civic Center Blvd, Children's Hospital Of Philadelphia, Philadelphia, PA 19104-4399 Ph: (215) 590-2708 | 
| Kewal Krishan, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Accepting Medicare Assignments Practice Location: 3509 N Broad St, Philadelphia, PA 19140 Phone: 215-707-8484 | |
| Cecillia Chin,  Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Medicare Enrolled Practice Location: 1025 Walnut St Ste 607, Philadelphia, PA 19107 Phone: 215-955-6996 | |
| Andrew S Wechsler, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Not Enrolled in Medicare Practice Location: 230 N Broad St, 744 N Tower, Philadelphia, PA 19102 Phone: 215-762-7802 Fax: 215-762-1858 | |
| Dr. Robert K Wenger, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Accepting Medicare Assignments Practice Location: 230 W Washington Sq, Philadelphia, PA 19106 Phone: 215-829-8713 Fax: 215-829-5350 | |
| Eros M Leotta, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Not Enrolled in Medicare Practice Location: 3509 N Broad St, Philadelphia, PA 19140 Phone: 215-707-8484 Fax: 215-707-3946 | |
| Larry Kaiser, MD Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Medicare Enrolled Practice Location: 3509 N Broad St, Philadelphia, PA 19140 Phone: 215-707-8484 Fax: 215-707-3946 | |
| Dr. Verdi J. Disesa, M.D. Thoracic Surgery (Cardiothoracic Vascular Surgery) Medicare: Not Enrolled in Medicare Practice Location: 3509 N Broad St, Philadelphia, PA 19140 Phone: 215-707-8484 Fax: 215-707-3946 |