Stanford Pediatric Surgery, LLC

Primary specialty

Pediatric Surgery PhysicianTaxonomy code 2086S0120X

License

MD419738 Issued in PA

Legal business name

STANFORD PEDIATRIC SURGERY, LLC

Practice address

419 Johnson St
Jenkintown, PA 19046-2705

Phone

(215) 792-2058

Fax

(215) 754-4295

NPI assigned

Aug 18, 2017

Last updated

Jul 21, 2022By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Dr. Ala Stanford, MDNPI 1750394037

Title

Founder/Director

Phone

(215) 817-8683

Specialties & licenses 2

Addresses

Other identifiers 1

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Ala Stanford

  • Surgery Physician
  • Charlotte, NC
  • NPI 1750394037
  NPD Authorized official

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

{
    "created_epoch": "1503014400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1658361600000",
    "number": "1922524123",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "ARCHWAYS PROFESSIONAL BUILDING",
            "address_2": "419 JOHNSON STREET",
            "city": "JENKINTOWN",
            "state": "PA",
            "postal_code": "190462705",
            "telephone_number": "215-792-2058",
            "fax_number": "215-754-4295"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 JOHNSON ST",
            "city": "JENKINTOWN",
            "state": "PA",
            "postal_code": "190462705",
            "telephone_number": "215-792-2058",
            "fax_number": "215-754-4295"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "STANFORD PEDIATRIC SURGERY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-08-18",
        "last_updated": "2022-07-21",
        "status": "A",
        "authorized_official_last_name": "STANFORD",
        "authorized_official_first_name": "ALA",
        "authorized_official_title_or_position": "FOUNDER/DIRECTOR",
        "authorized_official_telephone_number": "215-817-8683",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery",
            "state": "PA",
            "license": "MD419738",
            "primary": false
        },
        {
            "code": "2086S0120X",
            "taxonomy_group": "193400000X MULTIPLE SINGLE SPECIALTY GROUP",
            "desc": "Surgery, Pediatric Surgery",
            "state": "PA",
            "license": "MD419738",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "NPI",
            "identifier": "1750394037",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Pediatric Surgery Physician in Jenkintown, PA
• Providers in Jenkintown, PA by specialty
• Pediatric Surgery Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.