Healthcare Provider Details

I. General information

NPI: 1336251412
Provider Name (Legal Business Name): JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

P.O. BOX 632064
BALTIMORE MD
21263-2064
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0756
  • Fax: 410-550-1190
Mailing address:
  • Phone: 443-997-0001
  • Fax: 443-997-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number
License Number State

VIII. Authorized Official

Name: MS. JENNIFER NICKOLES
Title or Position: PRESIDENT
Credential:
Phone: 410-550-0100