Individual provider Active NPI

Stefanie L Davidson, M.D.

  • Ophthalmology Physician
  • Philadelphia, PA
National Provider Identifier
1619067725
Registry record updated Mar 13, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ophthalmology PhysicianTaxonomy code 207W00000X
License
MD0421384 Issued in PA
Practice address
34TH & Civic Center Blvd
The Children's Hospital of Philadelphia
Philadelphia, PA 19104-4306
Phone
(215) 590-2791
Fax
(215) 590-4325
NPI assigned
Oct 13, 2006
Last updated
Mar 13, 2013By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 13, 2013

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ophthalmology Physician 207W00000X MD0421384 PA Primary

Addresses

Primary practice location

34TH & Civic Center Blvd
The Children's Hospital of Philadelphia
Philadelphia, PA 19104-4306

Mailing address

100 East Penn Square
The Wanamaker Building 9TH FL
Philadelphia, PA 19107-3326
Phone (267) 425-9538

Other identifiers 1

IdentifierTypeStateIssuer
100952420MedicaidPA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in PA
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 1

Enrollment IDStateProvider typePAC IDDetails
I20040728000190 PA Practitioner - Ophthalmology 0840260832 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Ophthalmology
Education
Rutgers New Jersey Medical School, 1999
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

3401 Civic Ctr Blvd
Philadelphia, PA 19104-4319
Phone (267) 425-9505

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
MD0421384PAMDOphthalmology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Children's Surgical Associates LTD Current Accepting new patients
Children's Surgical Associates LTD CurrentSince Oct 3, 2022 Accepting new patients
Children's Surgical Associates LTD Past Accepting new patients
Children's Surgical Associates LTD Ophthalmology Past Accepting new patients
Children's Surgical Associates of New Jersey Inc Ophthalmology Past Accepting new patients
Children's Surgical Associates LTD Past Accepting new patients

Locations

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

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

3401 Civic Center Blvd
Ste 34
Philadelphia, PA 19104

3500 Civic Center Blvd
Philadelphia, PA 19104
Phone (215) 590-2169

Organizations & group practices 6

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.

NPI Registry JSON

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

{
    "created_epoch": "1160697600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1363132800000",
    "number": "1619067725",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 EAST PENN SQUARE",
            "address_2": "THE WANAMAKER BUILDING 9TH FL",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191073326",
            "telephone_number": "267-425-9538",
            "fax_number": "267-425-9552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "34TH & CIVIC CENTER BLVD",
            "address_2": "THE CHILDREN'S HOSPITAL OF PHILADELPHIA",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191044306",
            "telephone_number": "215-590-2791",
            "fax_number": "215-590-4325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DAVIDSON",
        "first_name": "STEFANIE",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-13",
        "last_updated": "2013-03-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207W00000X",
            "taxonomy_group": "",
            "desc": "Ophthalmology",
            "state": "PA",
            "license": "MD0421384",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100952420",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.