Healthcare Provider Details

I. General information

NPI: 1184272296
Provider Name (Legal Business Name): FEDERAL HILL PEDIATRIC CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2019
Last Update Date: 09/02/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 LIGHT ST STE A
BALTIMORE MD
21230-3813
US

IV. Provider business mailing address

724 LIGHT ST STE A
BALTIMORE MD
21230-3813
US

V. Phone/Fax

Practice location:
  • Phone: 304-813-8332
  • Fax:
Mailing address:
  • Phone: 304-813-8332
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH ELI LEBLANC
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 304-813-8332