Individual
MARK LEO JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3000 MON HEALTH MEDICAL PARK DR STE 3300, MORGANTOWN, WV 26505-1169
(304) 599-1448
(304) 599-5335
Mailing address
3000 MON HEALTH MEDICAL PARK DR STE 3300, MORGANTOWN, WV 26505-1169
(304) 599-1448
(304) 599-5335
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
18363
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001719640
BLUE CROSS BLUE SHIELD
—
05
—
0126399000
—
WV
01
—
PO1453582
RAILROAD MEDICARE
WV
01
—
WV5186C185
MEDICARE
WV
Enumeration date
10/23/2006
Last updated
04/01/2024
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