Provider Demographics
NPI:1699834630
Name:JOHANSSON, PATRIK LENNART
Entity Type:Individual
Prefix:DR
First Name:PATRIK
Middle Name:LENNART
Last Name:JOHANSSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1736 COLUMBIA RD NW
Mailing Address - Street 2:APT. 306
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2833
Mailing Address - Country:US
Mailing Address - Phone:202-574-6837
Mailing Address - Fax:202-574-7188
Practice Address - Street 1:1310 SOUTHERN AVENUE
Practice Address - Street 2:SUITE 200
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-574-6837
Practice Address - Fax:202-574-7188
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD34110207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine