Healthcare Provider Details

I. General information

NPI: 1699642439
Provider Name (Legal Business Name): CHILDREN'S HEART INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2025
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

120 SISTER PIERRE DR STE 504
TOWSON MD
21204-7527
US

IV. Provider business mailing address

171 ELDEN ST STE 2C4
HERNDON VA
20170-4875
US

V. Phone/Fax

Practice location:
  • Phone: 571-612-2600
  • Fax: 571-266-4096
Mailing address:
  • Phone: 571-612-2600
  • Fax: 571-266-4096

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology 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: KRISTIE BUTLER-SHUTTS
Title or Position: PRACTICE ADMIN
Credential:
Phone: 571-612-2600