1255790564 NPI number — JOHNS HOPKINS PEDIATRICS AT HOME, INC.

Table of content: (NPI 1255790564)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255790564 NPI number — JOHNS HOPKINS PEDIATRICS AT HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNS HOPKINS PEDIATRICS AT HOME, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255790564
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/08/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5901 HOLABIRD AVE
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21224-6015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-288-8000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5255 LOUGHBORO RD NW
Provider Second Line Business Practice Location Address:
ROOM GA-400
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-288-8000
Provider Business Practice Location Address Fax Number:
410-288-4369
Provider Enumeration Date:
02/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
MYERS
Authorized Official First Name:
MARY
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
410-288-8036

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HH7131 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: HH7131 . This is a "MARYLAND LICENSE (DC LICENSE PENDING)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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