Individual
INGRID DENISE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
8640 SUDLEY RD, SUITE 306, MANASSAS, VA 20110-4420
(703) 330-3939
(703) 331-0959
Mailing address
8640 SUDLEY RD STE 306, MANASSAS, VA 20110-4404
(703) 330-3939
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101058986
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6704433
—
VA
Enumeration date
07/20/2006
Last updated
07/01/2020
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