Basic Information
| Provider Information | |||||||||
| NPI: | 1851713168 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | JOHNS HOPKINS COMMUNITY PHYSICIANS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 418341 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022418341 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1501 S CLINTON ST | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212245730 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105229940 | ||||||||
| FaxNumber: | 4105229954 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/07/2014 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | GILLIGAN | ||||||||
| AuthorizedOfficialFirstName: | LINDA | ||||||||
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| AuthorizedOfficialTitleorPosition: | V.P. & C.O.O. | ||||||||
| AuthorizedOfficialTelephone: | 4103383636 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171100000X | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Other Service Providers | Acupuncturist |
No ID Information.