Provider Demographics
NPI:1205457124
Name:MARK JOHNSON, MD, PC
Entity type:Organization
Organization Name:MARK JOHNSON, MD, PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:240-641-5806
Mailing Address - Street 1:10801 LOCKWOOD DR STE 285
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-1556
Mailing Address - Country:US
Mailing Address - Phone:240-641-5806
Mailing Address - Fax:240-641-5834
Practice Address - Street 1:10801 LOCKWOOD DR STE 285
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-1556
Practice Address - Country:US
Practice Address - Phone:240-641-5806
Practice Address - Fax:240-641-5834
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-01
Last Update Date:2020-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service