Individual
DEREK K JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3903A FAIR RIDGE DR, FAIRFAX, VA 22033-2938
(703) 648-0030
(703) 648-9028
Mailing address
3903A FAIR RIDGE DR, FAIRFAX, VA 22033-2938
(703) 648-0030
(703) 648-9028
Taxonomy
Speciality
Code
Description
License number
State
2080P0201X
Pediatric Allergy/Immunology Physician
Primary
MD 065160L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0018751530003
—
PA
Enumeration date
10/13/2005
Last updated
02/27/2017
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