Basic Information
| Provider Information | |||||||||
| NPI: | 1922622737 | ||||||||
| 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 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 212242735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105500070 | ||||||||
| FaxNumber: | 4105500112 | ||||||||
| Practice Location | |||||||||
| Address1: | 5500 E. LOMBARD STREET | ||||||||
| Address2: | ROOM 1025 | ||||||||
| City: | BALTIMORE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 21224 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4105500070 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/08/2020 | ||||||||
| LastUpdateDate: | 06/08/2020 | ||||||||
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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: | 06/08/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.