Provider Demographics
NPI:1720186091
Name:THE JOHNS HOPKINS HOSPITAL
Entity Type:Organization
Organization Name:THE JOHNS HOPKINS HOSPITAL
Other - Org Name:JOHNS HOPKINS HOSPTIAL PEDIATRIC RENAL PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:VICE PRESIDENT, TREASURER, CFO,JHHS
Authorized Official - Prefix:MR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:J
Authorized Official - Last Name:WERTHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-955-6552
Mailing Address - Street 1:PO BOX 632051
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21263-2051
Mailing Address - Country:US
Mailing Address - Phone:443-997-0001
Mailing Address - Fax:443-997-0011
Practice Address - Street 1:600 NORTH WOLFE STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21287-1604
Practice Address - Country:US
Practice Address - Phone:410-955-9540
Practice Address - Fax:410-955-0856
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNS HOPKINS HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-09-20
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000065500Medicaid
MD000065500Medicaid