Provider Demographics
NPI:1235139387
Name:JOHNSON, ADOLPH WILLIAM JR (MD)
Entity Type:Individual
Prefix:
First Name:ADOLPH
Middle Name:WILLIAM
Last Name:JOHNSON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:12501 PROSPERITY DR STE 410
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1652
Mailing Address - Country:US
Mailing Address - Phone:301-368-0038
Mailing Address - Fax:301-328-0006
Practice Address - Street 1:12501 PROSPERITY DR STE 410
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1652
Practice Address - Country:US
Practice Address - Phone:301-368-0038
Practice Address - Fax:301-328-0006
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0033109207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDE53255Medicare UPIN
DC551144A74Medicare PIN