Healthcare Provider Details

I. General information

NPI: 1427611284
Provider Name (Legal Business Name): GENESIS PEDIATRICS OF MARYLAND ,INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2019
Last Update Date: 03/25/2025
Certification Date: 03/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8181 PROFESSIONAL PL STE 213
HYATTSVILLE MD
20785-7232
US

IV. Provider business mailing address

8181 PROFESSIONAL PL STE 213
HYATTSVILLE MD
20785-7232
US

V. Phone/Fax

Practice location:
  • Phone: 240-842-0680
  • Fax: 240-764-7477
Mailing address:
  • Phone: 240-842-0680
  • Fax: 240-764-7477

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHAEL ADERONKE OWOOJE
Title or Position: CEO
Credential: NURSE
Phone: 240-764-8892