Provider Demographics
NPI:1821080391
Name:JOHNSON, DARLENE S (MD)
Entity Type:Individual
Prefix:
First Name:DARLENE
Middle Name:S
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:DARLENE
Other - Middle Name:KARIN
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:1390 S POTOMAC ST
Mailing Address - Street 2:SUITE 124
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-6165
Mailing Address - Country:US
Mailing Address - Phone:303-368-8611
Mailing Address - Fax:303-368-9791
Practice Address - Street 1:1390 S POTOMAC ST
Practice Address - Street 2:SUITE 124
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-6165
Practice Address - Country:US
Practice Address - Phone:303-368-8611
Practice Address - Fax:303-368-9791
Is Sole Proprietor?:No
Enumeration Date:2005-08-19
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO41812207N00000X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
COP00176398OtherRR MEDICARE
CO68136366Medicaid
CO68136366Medicaid
COH18311Medicare UPIN