MEDICARE: JOHNS HOPKINS UNIVERSITY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RG0300X	Geriatric Medicine (Internal Medicine) Physician		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	CD2563	OTHER	MD	RRMC

General Provider Information

NPI Number	:	1104816172
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOHNS HOPKINS UNIVERSITY

Provider Business Mailing Address
First Line	:	PO BOX 64264
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-4264
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 N. WOLFE STREET
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21264-0001
Country	:	US
Telephone Number	:	410-558-5238
Fax Number	:

Authorized Official
Title or Position	:	SR PRODUCTION UNIT MGR
Name	:	SHAVONDA L KEATING
Credential	:
Telephone Number	:	410-933-6430

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/21/2022

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Directions to “JOHNS HOPKINS UNIVERSITY ” Practice Location

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