=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427611284
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GENESIS PEDIATRICS OF MARYLAND ,INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/17/2019
-----------------------------------------------------
Last Update Date | 03/25/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 8181 PROFESSIONAL PL STE 213
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-7232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-842-0680
-----------------------------------------------------
Fax | 240-764-7477
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8181 PROFESSIONAL PL STE 213
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-7232
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-842-0680
-----------------------------------------------------
Fax | 240-764-7477
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MRS. RACHAEL ADERONKE OWOOJE
-----------------------------------------------------
Credential | NURSE
-----------------------------------------------------
Telephone | 240-764-8892
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3140N1450X
-----------------------------------------------------
Taxonomy Name | Pediatric Skilled Nursing Facility
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 208000000X
-----------------------------------------------------
Taxonomy Name | Pediatrics Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------