Provider Demographics
NPI:1093587271
Name:JOHNSON, ELROY II
Entity Type:Individual
Prefix:
First Name:ELROY
Middle Name:
Last Name:JOHNSON
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2105 WINDHAM PL
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-4313
Mailing Address - Country:US
Mailing Address - Phone:202-378-6159
Mailing Address - Fax:
Practice Address - Street 1:2105 WINDHAM PL
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-4313
Practice Address - Country:US
Practice Address - Phone:202-378-6159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care