Healthcare Provider Details

I. General information

NPI: 1164593000
Provider Name (Legal Business Name): THE JOHNS HOPKINS HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 12/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 N BROADWAY
BALTIMORE MD
21205-1119
US

IV. Provider business mailing address

P.O. BOX 632051
BALTIMORE MD
21263-2051
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-5919
  • Fax: 410-550-7433
Mailing address:
  • Phone: 443-997-0001
  • Fax: 443-997-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number30-034
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number30-034
License Number StateMD

VIII. Authorized Official

Name: MR. RONALD J WERTHMAN
Title or Position: VICE PRESIDENT, TREASURER, CFO,JHHS
Credential:
Phone: 410-955-6552