Basic Information
| Provider Information | |||||||||
| NPI: | 1639701956 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4940 EASTERN AVENUE | ||||||||
| Address2: | COMMUNITY PSYCHIATRY PROGRAM ATTN TOM MARSHALL | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21224 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5500 E LOMBARD ST RM 1025 | ||||||||
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| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212241731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105500070 | ||||||||
| FaxNumber: | 4105500112 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/05/2020 | ||||||||
| LastUpdateDate: | 02/05/2020 | ||||||||
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| AuthorizedOfficialLastName: | OWENS | ||||||||
| AuthorizedOfficialFirstName: | PAMELA | ||||||||
| AuthorizedOfficialMiddleName: | TARRIS | ||||||||
| AuthorizedOfficialTitleorPosition: | CHIEF COMPLIANCE OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 4109557930 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/05/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0804X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 261QM0801X | Y | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) |
No ID Information.