Provider Demographics
NPI:1184272296
Name:FEDERAL HILL PEDIATRIC CENTER
Entity type:Organization
Organization Name:FEDERAL HILL PEDIATRIC CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RALPH
Authorized Official - Middle Name:ELI
Authorized Official - Last Name:LEBLANC
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-813-8332
Mailing Address - Street 1:724 LIGHT ST STE A
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-3813
Mailing Address - Country:US
Mailing Address - Phone:304-813-8332
Mailing Address - Fax:
Practice Address - Street 1:724 LIGHT ST STE A
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-3813
Practice Address - Country:US
Practice Address - Phone:304-813-8332
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-02
Last Update Date:2019-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD06660Medicaid
MD419330000Medicaid