Individual
MARK ANTONIO JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1140 VARNUM STREET NE, SUITE 106, WASHINGTON, DC 20017
(202) 448-4014
(202) 448-4082
Mailing address
1160 VARNUM ST NE, SUITE 300, WASHINGTON, DC 20017-2107
(202) 448-4014
(202) 448-4082
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
MD30469
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017148800
—
DC
01
—
16077
CHARTERED HEALTH PLAN
—
01
—
2063270
AETNA
—
01
—
392560
UNITED HEALTHCARE MAMSI
—
01
—
52821
AMERIGROUP
—
05
—
529000700
—
MD
01
—
F7920001
BLUE CROSS
—
Enumeration date
07/19/2006
Last updated
07/19/2013
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