Provider Demographics
NPI:1184646374
Name:JOHNSON, DAVID CHARLES (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CHARLES
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 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8102
Mailing Address - Country:US
Mailing Address - Phone:703-729-5010
Mailing Address - Fax:703-729-5833
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8102
Practice Address - Country:US
Practice Address - Phone:703-729-5010
Practice Address - Fax:703-729-5833
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101233087204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAH43085Medicare UPIN
VAP00634633Medicare PIN
VA00X6013N02Medicare PIN