Provider Demographics
NPI:1043794886
Name:JOHNSON, ORMANDA DOROTHEA (MD)
Entity Type:Individual
Prefix:
First Name:ORMANDA
Middle Name:DOROTHEA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-0008
Mailing Address - Country:US
Mailing Address - Phone:207-288-5119
Mailing Address - Fax:207-288-8449
Practice Address - Street 1:322 MAIN ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1648
Practice Address - Country:US
Practice Address - Phone:207-288-5119
Practice Address - Fax:207-288-8449
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMD21155207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMD21155OtherSTATE LICENSE