Provider Demographics
NPI:1427611284
Name:GENESIS PEDIATRICS OF MARYLAND ,INC.
Entity type:Organization
Organization Name:GENESIS PEDIATRICS OF MARYLAND ,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHAEL
Authorized Official - Middle Name:ADERONKE
Authorized Official - Last Name:OWOOJE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:240-764-8892
Mailing Address - Street 1:8181 PROFESSIONAL PL STE 213
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-7232
Mailing Address - Country:US
Mailing Address - Phone:240-842-0680
Mailing Address - Fax:240-764-7477
Practice Address - Street 1:8181 PROFESSIONAL PL STE 213
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-7232
Practice Address - Country:US
Practice Address - Phone:240-842-0680
Practice Address - Fax:240-764-7477
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-17
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, PediatricGroup - Single Specialty
No251J00000XAgenciesNursing Care
No385H00000XRespite Care FacilityRespite Care
No253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411385300Medicaid