Provider Demographics
NPI:1376520791
Name:JOHNSON, WALTER CARL (MD)
Entity Type:Individual
Prefix:DR
First Name:WALTER
Middle Name:CARL
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1564 MARY ELLEN CT
Mailing Address - Street 2:
Mailing Address - City:MC LEAN
Mailing Address - State:VA
Mailing Address - Zip Code:22101-5021
Mailing Address - Country:US
Mailing Address - Phone:703-356-0188
Mailing Address - Fax:703-805-9979
Practice Address - Street 1:9501 FARRELL RD
Practice Address - Street 2:INTERNAL MED., DEWITT ARMY HOSPITAL,,
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060-5901
Practice Address - Country:US
Practice Address - Phone:703-805-0329
Practice Address - Fax:703-805-9979
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2014-01-17
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Provider Licenses
StateLicense IDTaxonomies
VA0101023287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine