Individual
MR. KEVIN TIMOTHY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
411 NAYLOR MILL RD, SALISBURY, MD 21801-1191
(443) 669-9177
Mailing address
6125 WESTBURY DR, SALISBURY, MD 21801-1681
(443) 669-9177
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
C0001098
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA77250
CDS
MD
Enumeration date
01/06/2019
Last updated
01/06/2019
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