Healthcare Provider Details

I. General information

NPI: 1730841628
Provider Name (Legal Business Name): JOHNS HOPKINS REGIONAL PHYSICIANS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2021
Last Update Date: 03/20/2024
Certification Date: 03/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10805 HICKORY RIDGE RD STE 201
COLUMBIA MD
21044-3612
US

IV. Provider business mailing address

PO BOX 412709
BOSTON MA
02241-3276
US

V. Phone/Fax

Practice location:
  • Phone: 410-884-0191
  • Fax: 410-997-2607
Mailing address:
  • Phone: 410-760-8840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084N0008X
TaxonomyNeuromuscular Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTI MARTUCCI
Title or Position: JHRP BILLING ADMINISTRATOR
Credential:
Phone: 410-760-8840