Provider Demographics
NPI:1033672662
Name:JOHNSON, ABBY RACHEL ROSENBERG (MD)
Entity Type:Individual
Prefix:DR
First Name:ABBY
Middle Name:RACHEL ROSENBERG
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:ABBY
Other - Middle Name:RACHEL
Other - Last Name:ROSENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:8000 MARYLAND AVE STE 760
Mailing Address - Street 2:
Mailing Address - City:CLAYTON
Mailing Address - State:MO
Mailing Address - Zip Code:63105-3752
Mailing Address - Country:US
Mailing Address - Phone:314-474-0114
Mailing Address - Fax:
Practice Address - Street 1:8000 MARYLAND AVE STE 760
Practice Address - Street 2:
Practice Address - City:CLAYTON
Practice Address - State:MO
Practice Address - Zip Code:63105-3752
Practice Address - Country:US
Practice Address - Phone:314-474-0114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-10
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2023037139207N00000X
MO2019018216207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology