Healthcare Provider Details

I. General information

NPI: 1003972530
Provider Name (Legal Business Name): JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4940 EASTERN AVE BMO BUILDING, ROOM 01-0154
BALTIMORE MD
21224-2735
US

IV. Provider business mailing address

PO BOX 418854
BOSTON MA
02241-8854
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0961
  • Fax: 410-550-5566
Mailing address:
  • Phone: 443-997-0001
  • Fax: 443-997-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP02057
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code3336C0002X
TaxonomyClinic Pharmacy
License NumberP02057
License Number StateMD

VIII. Authorized Official

Name: MR. CARL HENRY FRANCIOLI
Title or Position: VICE PRESIDENT OF FINANCE
Credential:
Phone: 410-955-6552