Healthcare Provider Details

I. General information

NPI: 1407682503
Provider Name (Legal Business Name): MT. WASHINGTON PEDIATRIC HOSPITAL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/13/2024
Last Update Date: 09/16/2024
Certification Date: 09/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 HARRY S TRUMAN DR N FL 8
LARGO MD
20774-5477
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:
Mailing address:
  • Phone: 410-578-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

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