Provider Demographics
NPI:1235498924
Name:JOHNSTON, JORDANNA (MD)
Entity Type:Individual
Prefix:
First Name:JORDANNA
Middle Name:
Last Name:JOHNSTON
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:PO BOX 791344
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21279-1344
Mailing Address - Country:US
Mailing Address - Phone:240-566-1600
Mailing Address - Fax:240-566-1605
Practice Address - Street 1:7490 NEW TECHNOLOGY WAY
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21703-8370
Practice Address - Country:US
Practice Address - Phone:240-566-1600
Practice Address - Fax:240-566-1605
Is Sole Proprietor?:No
Enumeration Date:2012-05-15
Last Update Date:2016-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0081053207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology