Provider Demographics
NPI:1710342464
Name:THE JOHNS HOPKINS HOSPITAL
Entity Type:Organization
Organization Name:THE JOHNS HOPKINS HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, PHCY SERVICES, AO
Authorized Official - Prefix:
Authorized Official - First Name:MITRA
Authorized Official - Middle Name:
Authorized Official - Last Name:GAVGANI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-288-8766
Mailing Address - Street 1:PO BOX 418243
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02241-2145
Mailing Address - Country:US
Mailing Address - Phone:410-288-8060
Mailing Address - Fax:410-367-2145
Practice Address - Street 1:600 N. WOLFE ST, CARNEGIE BUILDING, 2ND FL., ROOM 224
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287
Practice Address - Country:US
Practice Address - Phone:443-287-1744
Practice Address - Fax:443-287-1744
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-23
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MDP076823336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2160282OtherPK
MD441184600Medicaid