| Johns Hopkins Bayview Medical Center | |
|
1821 Portal Street Suite B Baltimore MD 21224-6518 | |
| (410) 550-0070 | |
| (410) 550-1061 |
| Full Name | Johns Hopkins Bayview Medical Center |
|---|---|
| Speciality | Clinic/center - Adolescent And Children Mental Health |
| Location | 1821 Portal Street, Baltimore, Maryland |
| Authorized Official Name and Position | Jennifer Nickoles (PRESIDENT) |
| Authorized Official Contact | 4109556552 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Johns Hopkins Bayview Medical Center Po Box 632053 Baltimore MD 21263-0001 Ph: (443) 997-0001 | Johns Hopkins Bayview Medical Center 1821 Portal Street Suite B Baltimore MD 21224-6518 Ph: (410) 550-0070 |
| NPI Number | 1639231541 |
|---|---|
| Provider Enumeration Date | 12/15/2006 |
| Last Update Date | 07/11/2025 |
| Certification Date | 07/11/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1639231541 | NPI | - | NPPES |
| 58853110 | Other | MA CONTRACTOR | |
| 006700801 | Medicaid | MD | |
| 046611500 | Other | MA CONTRACTOR |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | 30005 (Maryland) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | 30005 (Maryland) | Primary |
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