Provider Demographics
NPI:1134118326
Name:JOHNSON, WILLIAM HENRY (MD,)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:HENRY
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 1:140 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4402
Mailing Address - Country:US
Mailing Address - Phone:301-694-7788
Mailing Address - Fax:301-694-3184
Practice Address - Street 1:140 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 202
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4402
Practice Address - Country:US
Practice Address - Phone:301-694-7788
Practice Address - Fax:301-694-3184
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-19
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0047556207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD706L427DMedicare PIN
MDF54963Medicare UPIN