Basic Information
| Provider Information | |||||||||
| NPI: | 1356088397 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNS HOPKINS UNIVERSITY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6201 GREENLEIGH AVE | ||||||||
| Address2: | |||||||||
| City: | MIDDLE RIVER | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212202004 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109336423 | ||||||||
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| Practice Location | |||||||||
| Address1: | 6000 RADECKE AVE | ||||||||
| Address2: | |||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212063955 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4106149409 | ||||||||
| FaxNumber: | 4103673304 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2022 | ||||||||
| LastUpdateDate: | 05/19/2022 | ||||||||
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| AuthorizedOfficialLastName: | KEATING | ||||||||
| AuthorizedOfficialFirstName: | SHAVONDA | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | ASSOCIATE DIRECTOR A/R OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 4109336430 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | JOHNS HOPKINS UNIVERSITY | ||||||||
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| NPICertificationDate: | 05/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RE0101X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism |
No ID Information.