Healthcare Provider Details

I. General information

NPI: 1225590383
Provider Name (Legal Business Name): JOHN HOPKINS FOUNTAIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2019
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 FRUIT ST
BOSTON MA
02114-2621
US

IV. Provider business mailing address

330 MOUNT AUBURN ST PARSONS 2
CAMBRIDGE MA
02138-5597
US

V. Phone/Fax

Practice location:
  • Phone: 617-724-9674
  • Fax:
Mailing address:
  • Phone: 617-354-8771
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0200X
TaxonomyCritical Care Medicine (Internal Medicine) Physician
License Number1019462
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number314912
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207RP1001X
TaxonomyPulmonary Disease Physician
License Number1019462
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1019462
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: