Individual
KEVIN MAURICE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
0101245083
VA
2085R0202X
Diagnostic Radiology Physician
D0088050
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0101245083
MEDICAL LICENSE
VA
01
—
0109
CAREFIRST BCBS
VA
01
—
282568
KAISER PERMANENTE
VA
01
—
3848144
AETNA - HMO
VA
01
—
9592327
AETNA - PPO
VA
Enumeration date
04/29/2008
Last updated
01/27/2020
Update your record
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