Individual
DR. EDWARD ALEX JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
811 REDGATE AVE, NORFOLK, VA 23507-1515
(757) 668-7007
Mailing address
811 REDGATE AVE, NORFOLK, VA 23507-1515
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101249802
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
186RL
BCBS NC
NC
05
—
1902079015
—
NC
05
—
315974
—
SC
Enumeration date
04/09/2008
Last updated
02/19/2019
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