Provider Demographics
NPI:1144780925
Name:JOHNSON, MARK DANIEL (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:DANIEL
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:UNIVERSITY OF CINCINNATI DEPARTMENT OF NEUROSURGERY
Mailing Address - Street 2:231 ALBERT SABIN WAY, ML 515
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45267-0515
Mailing Address - Country:US
Mailing Address - Phone:513-558-3903
Mailing Address - Fax:513-558-3335
Practice Address - Street 1:234 GOODMAN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-0796
Practice Address - Country:US
Practice Address - Phone:513-558-3903
Practice Address - Fax:513-558-3335
Is Sole Proprietor?:No
Enumeration Date:2019-03-20
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program