Provider Demographics
NPI:1073692794
Name:JOHNS HOPKINS PEDIATRICS AT HOME, INC.
Entity Type:Organization
Organization Name:JOHNS HOPKINS PEDIATRICS AT HOME, INC.
Other - Org Name:JOHNS HOPKINS PEDIATRICS AT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE/CFO
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:VAN DANIKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-288-7097
Mailing Address - Street 1:5901 HOLABIRD AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-6015
Mailing Address - Country:US
Mailing Address - Phone:410-288-8095
Mailing Address - Fax:410-288-8952
Practice Address - Street 1:5901 HOLABIRD AVE
Practice Address - Street 2:SUITE A
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-6015
Practice Address - Country:US
Practice Address - Phone:410-288-8095
Practice Address - Fax:410-288-8952
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-03
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH7131332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD498568100Medicaid
MDME98OtherBLUE CROSS