Provider Demographics
NPI:1093746885
Name:JOHNSON, HARRY W (MD)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
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 64551
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21264-4551
Mailing Address - Country:US
Mailing Address - Phone:667-214-1302
Mailing Address - Fax:410-328-3379
Practice Address - Street 1:419 W REDWOOD ST
Practice Address - Street 2:SUITE 500
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-1734
Practice Address - Country:US
Practice Address - Phone:667-214-1300
Practice Address - Fax:410-328-3379
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0038053207V00000X
MDD380532088F0040X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No2088F0040XAllopathic & Osteopathic PhysiciansUrologyFemale Pelvic Medicine and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD346311700Medicaid
MD160024004Medicare PIN
MD346311700Medicaid