Provider Demographics
NPI:1275606162
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:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:G
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-288-8036
Mailing Address - Street 1:5901 HOLABIRD AVENUE
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:410-288-8036
Mailing Address - Fax:410-288-4369
Practice Address - Street 1:5901 HOLABIRD AVENUE
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:410-288-8036
Practice Address - Fax:410-288-4369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2021-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDHH71313336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDFT72JOOtherCF-MARYLAND
MD498568100OtherSUPPLIES
MDF304OtherCF-GHMSI/FEP