Provider Demographics
NPI:1912103177
Name:JOHNS HOPKINS UNIVERSITY
Entity Type:Organization
Organization Name:JOHNS HOPKINS UNIVERSITY
Other - Org Name:JHU - PEDIATRIC GENETICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR PRODUCTION UNIT MGR
Authorized Official - Prefix:
Authorized Official - First Name:SHAVONDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:KEATING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-933-6430
Mailing Address - Street 1:PO BOX 64316
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4316
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1812 ASHLAND AVE STE 200
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21205-1506
Practice Address - Country:US
Practice Address - Phone:410-614-0369
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNS HOPKINS UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207SG0201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No207SG0201XAllopathic & Osteopathic PhysiciansMedical GeneticsClinical Genetics (M.D.)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD405131900Medicaid
MDCD6085OtherRRMC
MD405131900Medicaid