Healthcare Provider Details

I. General information

NPI: 1639701956
Provider Name (Legal Business Name): JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2020
Last Update Date: 02/05/2020
Certification Date: 02/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 E LOMBARD ST RM 1025
BALTIMORE MD
21224-1731
US

IV. Provider business mailing address

4940 EASTERN AVENUE COMMUNITY PSYCHIATRY PROGRAM ATTN TOM MARSHALL
BALTIMORE MD
21224
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0070
  • Fax: 410-550-0112
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: PAMELA TARRIS OWENS
Title or Position: CHIEF COMPLIANCE OFFICER
Credential:
Phone: 410-955-7930