Individual
DOMINIC A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
736 BATTLEFIELD BLVD N, CHESAPEAKE GENERAL HOSPITAL, CHESAPEAKE, VA 23320-4941
(757) 312-6200
Mailing address
4536 BONNEY RD, VIRGINIA BEACH, VA 23462-3869
(757) 490-9388
(757) 490-9401
Taxonomy
Speciality
Code
Description
License number
State
207PE0004X
Emergency Medical Services (Emergency Medicine) Physician
Primary
0101049402
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0633R
BLUE CROSS BLUE SHIELD NC
—
01
—
082480
BLUE CROSS BLUE SHIELD VA
—
01
—
251490
MAMSI/MDIPA
—
01
—
27936
OPTIMA
—
01
—
3900570
OPTIMUM CHOICE
—
01
—
790633R
MEDICAID
NC
Enumeration date
08/15/2006
Last updated
07/08/2007
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