Provider Demographics
NPI:1093822538
Name:JOHNSON, PATRICIA A (DO)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:A
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 BRAMBLE ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-2408
Mailing Address - Country:US
Mailing Address - Phone:410-901-2000
Mailing Address - Fax:
Practice Address - Street 1:100 BRAMBLE ST
Practice Address - Street 2:SUITE 3
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-2408
Practice Address - Country:US
Practice Address - Phone:410-901-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0059973207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402327700Medicaid
MD613M984FMedicare ID - Type Unspecified
MD402327700Medicaid