Individual
LYDIA JONES JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
5201 HICKORY PARK DR STE A, GLEN ALLEN, VA 23059-2623
(804) 262-6060
(804) 262-6422
Mailing address
801 YORK ST, MANITOWOC, WI 54220-4630
(920) 663-9008
(920) 684-1439
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
0101230897
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005901952
—
VA
01
—
0300353
UNITED HEALTHCARE
—
01
—
070015801
RAILROAD MEDICARE
—
01
—
147156
SOUTHERN HEALTH
—
01
—
217925
ANTHEM
—
01
—
7214219
AETNA
—
Enumeration date
07/29/2005
Last updated
06/10/2024
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