Provider Demographics
NPI:1073546925
Name:JOHNSON, SUSAN H (MD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
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 1:34503 9TH AVE S
Mailing Address - Street 2:STE 330
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8726
Mailing Address - Country:US
Mailing Address - Phone:253-383-3695
Mailing Address - Fax:253-661-1987
Practice Address - Street 1:34503 9TH AVE S
Practice Address - Street 2:STE 330
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-8726
Practice Address - Country:US
Practice Address - Phone:253-383-3695
Practice Address - Fax:253-661-1987
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD17446207VG0400X
WAMD60287595207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0296298OtherSTATE L&I
OR160059803OtherRAILROAD MEDICARE
OR8145617Medicaid
WAG8910246Medicare PIN
OR8145617Medicaid
OR160059803OtherRAILROAD MEDICARE