Provider Demographics
NPI:1184489791
Name:JOHNS HOPKINS PERSONALIZED CARE
Entity type:Organization
Organization Name:JOHNS HOPKINS PERSONALIZED CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR PROVIDER ENROLLMENT
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONDA
Authorized Official - Middle Name:
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-302-2229
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-6430
Mailing Address - Fax:
Practice Address - Street 1:10751 FALLS RD STE 303
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-4551
Practice Address - Country:US
Practice Address - Phone:410-933-1200
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-14
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty