Basic Information
| Provider Information | |||||||||
| NPI: | 1922098466 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | JOHNS HOPKINS EMERGENCY MEDICAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 418937 | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 022418937 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405291456 | ||||||||
| FaxNumber: | 3016315589 | ||||||||
| Practice Location | |||||||||
| Address1: | 5755 CEDAR LN | ||||||||
| Address2: | |||||||||
| City: | COLUMBIA | ||||||||
| State: | MD | ||||||||
| PostalCode: | 210442912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2405291456 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/26/2005 | ||||||||
| LastUpdateDate: | 10/22/2013 | ||||||||
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| AuthorizedOfficialLastName: | HAINES | ||||||||
| AuthorizedOfficialFirstName: | CHANTELL | ||||||||
| AuthorizedOfficialMiddleName: | MARIE | ||||||||
| AuthorizedOfficialTitleorPosition: | SUPERVISOR | ||||||||
| AuthorizedOfficialTelephone: | 2405291456 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MISS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QE0002X | Y | Ambulatory Health Care Facilities | Clinic/Center | Emergency Care |
ID Information
| ID | Type | State | Issuer | Description | CH7643 | 01 | MD | RAILROAD MEDICARE | OTHER | 022004300 | 05 | MD | MEDICAID | F754 | 01 | MD | BCBS FEDERAL | OTHER | LV01 | 01 | MD | BCBS | OTHER |