Provider Demographics
NPI:1497887178
Name:JOHNSON, MICHELLE D (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:D
Last Name:JOHNSON
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 1:110 HOSPITAL RD STE 203
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-4045
Mailing Address - Country:US
Mailing Address - Phone:410-414-4740
Mailing Address - Fax:410-414-4741
Practice Address - Street 1:110 HOSPITAL RD STE 203
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-4045
Practice Address - Country:US
Practice Address - Phone:410-414-4740
Practice Address - Fax:410-414-4741
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0051814207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
3263171OtherAETNA US HEALTHCARE
548502-06OtherBLUE SHIELD OF MARYLAND
MD759211601Medicaid
6906-0005OtherBLUE SHIELD DC
352091OtherMAMSI UNITED HEALTH CARE
MD059N905FMedicare ID - Type Unspecified