Provider Demographics
NPI:1164454740
Name:JOHNSON-THREAT, YVETTE C (MD)
Entity Type:Individual
Prefix:
First Name:YVETTE
Middle Name:C
Last Name:JOHNSON-THREAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 N 28TH ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23223-5311
Mailing Address - Country:US
Mailing Address - Phone:804-644-1665
Mailing Address - Fax:804-644-5285
Practice Address - Street 1:1510 N 28TH ST
Practice Address - Street 2:SUITE 308
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23223-5311
Practice Address - Country:US
Practice Address - Phone:804-644-1665
Practice Address - Fax:804-644-5285
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2009-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101054237207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA2104493OtherMAMSI
VA5487309OtherAETNA LIFE
VAP00153281OtherRAILROAD MEDICARE
VA6246708OtherCIGNA
VA463643OtherANTHEM BCBS OF VA
VA65960OtherSENTARA
VA010023921Medicaid
VA5487309OtherAETNA HMO
VA212408OtherSOUTHERN HEALTH SERVICES
VA463643OtherANTHEM BCBS OF VA
VAG18784Medicare UPIN