| Jhu - Medicine/geriatrics | |
|
600 N. Wolfe Street Baltimore MD 21264-0001 | |
| (410) 558-5238 | |
| Not Available |
| Full Name | Jhu - Medicine/geriatrics |
|---|---|
| Speciality | Internal Medicine |
| Location | 600 N. Wolfe Street, Baltimore, Maryland |
| Authorized Official Name and Position | Shavonda L Keating (SR PRODUCTION UNIT MGR) |
| Authorized Official Contact | 4109336430 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jhu - Medicine/geriatrics Po Box 64264 Baltimore MD 21264-4264 Ph: () - | Jhu - Medicine/geriatrics 600 N. Wolfe Street Baltimore MD 21264-0001 Ph: (410) 558-5238 |
| NPI Number | 1104816172 |
|---|---|
| Provider Enumeration Date | 10/21/2005 |
| Last Update Date | 07/21/2022 |
| Medicare PECOS PAC ID | 8921903147 |
|---|---|
| Medicare Enrollment ID | O20130530000068 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1104816172 | NPI | - | NPPES |
| 055237400 | Medicaid | DC | |
| 691105600 | Medicaid | MD | |
| CD2563 | Other | MD | RRMC |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (Maryland) | Primary |
| Provider Name | Samuel C Durso |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1386691541 PECOS PAC ID: 9234322736 Enrollment ID: I20130604000812 |
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