Provider Demographics
NPI:1790121234
Name:CHILDREN'S HOSPITAL
Entity Type:Organization
Organization Name:CHILDREN'S HOSPITAL
Other - Org Name:BLUE DISTINCTION CENTER FOR TRANSPLANT
Other - Org Type:Other Name
Authorized Official - Title/Position:SR MANAGER, MEDICAL STAFF SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PFENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-476-4447
Mailing Address - Street 1:PO BOX 37212
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-3212
Mailing Address - Country:US
Mailing Address - Phone:301-572-3625
Mailing Address - Fax:301-572-3699
Practice Address - Street 1:111 MICHIGAN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-2916
Practice Address - Country:US
Practice Address - Phone:202-476-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHILDREN'S HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-10
Last Update Date:2013-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant SurgeryGroup - Single Specialty