Provider Demographics
NPI:1548352461
Name:OZANNE-JOHNSON, CHARLENE (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLENE
Middle Name:
Last Name:OZANNE-JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLENE
Other - Middle Name:
Other - Last Name:OZANNE-BLANKFARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7125 BANJO COURT
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045
Mailing Address - Country:US
Mailing Address - Phone:301-598-1590
Mailing Address - Fax:301-598-1569
Practice Address - Street 1:3305 N LIESURE WORLD BLVD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906
Practice Address - Country:US
Practice Address - Phone:301-598-1590
Practice Address - Fax:301-598-1569
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD43202207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD640700500Medicaid
MD729055Medicare PIN
MD640700500Medicaid