Provider Demographics
NPI:1558465013
Name:JOHNSON, VALERIE A (MD)
Entity Type:Individual
Prefix:
First Name:VALERIE
Middle Name:A
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 1:500 PORTAGE LAKES DR
Mailing Address - Street 2:STE. B
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44319-2299
Mailing Address - Country:US
Mailing Address - Phone:330-645-6934
Mailing Address - Fax:330-645-6935
Practice Address - Street 1:500 PORTAGE LAKES DR
Practice Address - Street 2:STE. B
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44319-2299
Practice Address - Country:US
Practice Address - Phone:330-645-6934
Practice Address - Fax:330-645-6935
Is Sole Proprietor?:No
Enumeration Date:2006-09-12
Last Update Date:2011-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35087905207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2738970Medicaid
OH2738970Medicaid
I63594Medicare UPIN