Provider Demographics
NPI:1356474225
Name:JOHNSON, SHARIDAN (CHIEF TECHNOLOGIST)
Entity Type:Individual
Prefix:MR
First Name:SHARIDAN
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CHIEF TECHNOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 W 23RD ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21218-5605
Mailing Address - Country:US
Mailing Address - Phone:410-662-9729
Mailing Address - Fax:410-662-9130
Practice Address - Street 1:3 W 23RD ST FL 2
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-5605
Practice Address - Country:US
Practice Address - Phone:410-662-9729
Practice Address - Fax:410-662-9130
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR00023872471C3402X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2471C3402XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistRadiography