Provider Demographics
NPI:1629412077
Name:JOHNSON, COURTNEY WILLOUGHBY (MD)
Entity Type:Individual
Prefix:DR
First Name:COURTNEY
Middle Name:WILLOUGHBY
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8710 CAMERON ST UNIT 812
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3726
Mailing Address - Country:US
Mailing Address - Phone:301-675-7867
Mailing Address - Fax:
Practice Address - Street 1:10903 NEW HAMPSHIRE AVE BLDG 71
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20993-4509
Practice Address - Country:US
Practice Address - Phone:888-463-6332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-28
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCDC0445252080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-Oncology