Healthcare Provider Details

I. General information

NPI: 1174797435
Provider Name (Legal Business Name): MT. WASHINGTON PEDIATRIC HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2008
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1708 W ROGERS AVE
BALTIMORE MD
21209-4545
US

IV. Provider business mailing address

1708 W ROGERS AVE
BALTIMORE MD
21209-4545
US

V. Phone/Fax

Practice location:
  • Phone: 410-578-8600
  • Fax: 410-578-0567
Mailing address:
  • Phone: 410-578-8600
  • Fax: 410-578-0567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code283XC2000X
TaxonomyChildren's Rehabilitation Hospital
License Number30-026
License Number StateMD

VIII. Authorized Official

Name: MS. MARY MILLER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 410-578-5163