Individual
KEVIN MAURICE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2722 MERRILEE DR, SUITE 230, FAIRFAX, VA 22031-4420
(703) 698-4483
(703) 698-2176
Mailing address
2722 MERRILEE DR, SUITE 230, FAIRFAX, VA 22031-4420
(703) 698-4483
(703) 698-2176
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
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