Provider Demographics
NPI:1144109505
Name:HORMONES & IMMUNOLOGY PERSONALIZED MEDICINE
Entity type:Organization
Organization Name:HORMONES & IMMUNOLOGY PERSONALIZED MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LAVON
Authorized Official - Middle Name:JEANINE
Authorized Official - Last Name:MAGRUDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-204-1134
Mailing Address - Street 1:100 OWINGS CT STE 12
Mailing Address - Street 2:
Mailing Address - City:REISTERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21136-6434
Mailing Address - Country:US
Mailing Address - Phone:410-220-5600
Mailing Address - Fax:
Practice Address - Street 1:100 OWINGS COURT
Practice Address - Street 2:STE 12
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136
Practice Address - Country:US
Practice Address - Phone:410-220-5600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-29
Last Update Date:2025-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty