Healthcare Provider Details

I. General information

NPI: 1639231541
Provider Name (Legal Business Name): JOHNS HOPKINS BAYVIEW MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2006
Last Update Date: 07/11/2025
Certification Date: 07/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1821 PORTAL STREET SUITE B
BALTIMORE MD
21224-6518
US

IV. Provider business mailing address

PO BOX 632053
BALTIMORE MD
21263-0001
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0070
  • Fax: 410-550-1061
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 Number30005
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number30005
License Number StateMD

VIII. Authorized Official

Name: MS. JENNIFER NICKOLES
Title or Position: PRESIDENT
Credential:
Phone: 410-955-6552