Individual provider Active NPI

Stephanie Fuller, M.D.

  • Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
  • Philadelphia, PA
National Provider Identifier
1013115930
Registry record updated Dec 9, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Thoracic Surgery (Cardiothoracic Vascular Surgery) PhysicianTaxonomy code 208G00000X
License
D0105511 Issued in MD
Practice address
34TH & Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104-4399
Phone
(215) 590-2708
Fax
(215) 590-2715
NPI assigned
Jul 3, 2007
Last updated
Dec 9, 2025By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 9, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Surgery Physician 208600000X MD420734 PA
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X D0105511 MD Primary
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician 208G00000X MD420734 PA

Addresses

Primary practice location

34TH & Civic Center Blvd
Children's Hospital of Philadelphia
Philadelphia, PA 19104-4399

Mailing address

6201 Greenleigh Ave
Middle River, MD 21220-2004
Phone (410) 955-5000

Other practice location 1

1800 Orleans St
Baltimore, MD 21287-0010
Phone (410) 955-5000 ext. 32704

Other identifiers 1

IdentifierTypeStateIssuer
100743887-0030MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA, NJ, MD3 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 3

Enrollment IDStateProvider typePAC IDDetails
I20080909000244 PA Practitioner - Thoracic Surgery 9537235908 Reassigns benefits to 1 organization
I20201012000690 NJ Practitioner - Thoracic Surgery 9537235908 Reassigns benefits to 1 organization
I20251218000416 MD Practitioner - Cardiac Surgery 9537235908 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Cardiac Surgery
Education
Eastern Virginia Medical School, 1999
Medicare assignment
May accept Medicare assignment
Telehealth
Offers telehealth services
Group practices
Johns Hopkins UniversityGroup PAC ID 8921903147, 2,886 clinicians

Practice addresses (Care Compare)

1800 Orleans St
Baltimore, MD 21287-0010
Phone (410) 955-5000

600 N Wolf St
Baltimore, MD 21287-0005
Phone (410) 955-5000

600 N Wolfe St
Blalock 266
Baltimore, MD 21287-0005
Phone (410) 502-4340

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD420734PAMDSurgery Physician
D0105511MDMDThoracic Surgery (Cardiothoracic Vascular Surgery) Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Surgical Associates LTD CurrentSince Oct 3, 2022 Accepting new patients
Johns Hopkins University CurrentSince Dec 1, 2025 Accepting new patients
Children's Surgical Associates of New Jersey Inc CurrentSince Jun 20, 2020 Accepting new patients
Johns Hopkins University Surgery CurrentSince Dec 1, 2025 Accepting new patients
Children's Surgical Associates of New Jersey Inc CurrentSince Jun 20, 2020 Accepting new patients
Children's Surgical Associates of New Jersey Inc Surgery Current Accepting new patients

Locations

1800 Orleans St
Baltimore, MD 21287
Phone (410) 502-2037

600 N Wolfe St
Baltimore, MD 21287

6201 Greenleigh Ave
Middle River, MD 21220
Phone (410) 933-2704

4009 Black Horse Pike
Mays Landing, NJ 08330
Phone (267) 425-9505

101 Plainsboro Rd
Plainsboro, NJ 08536
Phone (267) 425-9505

1012 Laurel Oak Rd
Voorhees, NJ 08043
Phone (856) 435-0086

200 Bowman Dr
Fl 2
Voorhees, NJ 08043
Phone (267) 425-5400

100 E Penn Sq
Bldg 9TH
Philadelphia, PA 19107
Phone (267) 425-9538

100 E Penn Sq
Fl 9
Philadelphia, PA 19107
Phone (267) 425-9232

3401 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-4040

Organizations & group practices 7

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1183420800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1765238400000",
    "number": "1013115930",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6201 GREENLEIGH AVE",
            "city": "MIDDLE RIVER",
            "state": "MD",
            "postal_code": "212202004",
            "telephone_number": "410-955-5000",
            "fax_number": "410-500-4266"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34TH & CIVIC CENTER BLVD",
            "address_2": "CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044399",
            "telephone_number": "215-590-2708",
            "fax_number": "215-590-2715"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Orleans St",
            "address_purpose": "LOCATION",
            "city": "Baltimore",
            "state": "MD",
            "postal_code": "212870010",
            "country_code": "US",
            "telephone_number": "410-955-5000 x32704",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FULLER",
        "first_name": "STEPHANIE",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-07-03",
        "last_updated": "2025-12-09",
        "certification_date": "2025-12-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD420734",
            "primary": false
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "MD",
            "license": "D0105511",
            "primary": true
        },
        {
            "code": "208G00000X",
            "taxonomy_group": "",
            "desc": "Thoracic Surgery (Cardiothoracic Vascular Surgery)",
            "state": "PA",
            "license": "MD420734",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100743887-0030",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.