Provider Demographics
NPI:1801864343
Name:JOHNSON, TIMOTHY STERLING (MD)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:STERLING
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19455 DEERFIELD AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:LANSDOWNE
Mailing Address - State:VA
Mailing Address - Zip Code:20176-8100
Mailing Address - Country:US
Mailing Address - Phone:703-729-5010
Mailing Address - Fax:703-729-5833
Practice Address - Street 1:19455 DEERFIELD AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:LANSDOWNE
Practice Address - State:VA
Practice Address - Zip Code:20176-8100
Practice Address - Country:US
Practice Address - Phone:703-729-5010
Practice Address - Fax:703-729-5833
Is Sole Proprietor?:No
Enumeration Date:2006-03-10
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058682207X00000X
VA0101238208207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00X6013N01Medicare PIN
H65683Medicare UPIN