Provider Demographics
NPI:1578569240
Name:JOHNS HOPKINS UNIVERSITY
Entity type:Organization
Organization Name:JOHNS HOPKINS UNIVERSITY
Other - Org Name:<UNAVAIL>
Other - Org Type:
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 64286
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4286
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8600 OLD GEORGETOWN RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-1422
Practice Address - Country:US
Practice Address - Phone:410-955-5000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:JOHNS HOPKINS UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-06-27
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC060392200Medicaid
MDCD6081OtherRRMC
MD134971600Medicaid