Provider Demographics
NPI:1619990744
Name:JOHNSON, MARY JOHANNA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOHANNA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:MARY
Other - Middle Name:JOHANNA
Other - Last Name:GUTBERLET
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 12622
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4017
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:185 HARRY S TRUMAN PKWY STE 120
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-7580
Practice Address - Country:US
Practice Address - Phone:410-224-4442
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2019-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD435925207VM0101X
MDD35702207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK4800009OtherBCBS
MD211641301Medicaid
PA280835OtherUNISON-YHCHC
MD732204OtherMEDICARE
PA102246423Medicaid
PA20086849OtherAMERIHEALTH MERCY - WMG
PA20091825OtherAMERIHEALTH MERCY-YH
MD211641300Medicaid
MD400525OtherCAREFIRST MD BCBS
PA123846OtherGEISINGER HEALTH PLAN
PA20087483OtherAMERIHEALTH MERCY-WMG
PA261018OtherUNISON-WMG
PA30139634OtherAMERIHEALTH MERCY-YHOBGYN
PA701408OtherHIGHMARK BLUE SHIELD
PA019135OtherJOHNS HOPKINS
PA1578891OtherGATEWAY-WMG
PA50083119OtherCAPITAL BLUE CROSS-WMG
PA019135OtherJOHNS HOPKINS