Provider Demographics
NPI:1679030605
Name:WIRTSHAFTER, STEPHANIE (DO)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:
Last Name:WIRTSHAFTER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 E. MORELAND AVE.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-3562
Mailing Address - Country:US
Mailing Address - Phone:267-385-5538
Mailing Address - Fax:267-437-3176
Practice Address - Street 1:10 E. MORELAND AVE.
Practice Address - Street 2:SUITE 100
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19118-3562
Practice Address - Country:US
Practice Address - Phone:267-437-3176
Practice Address - Fax:267-437-3176
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-26
Last Update Date:2024-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS021115207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty