Provider Demographics
NPI:1891127015
Name:JOHNSON, JANICE MARIE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANICE
Middle Name:MARIE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3731 N COUNTRY CLUB DR
Mailing Address - Street 2:728
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1733
Mailing Address - Country:US
Mailing Address - Phone:732-249-7654
Mailing Address - Fax:
Practice Address - Street 1:3731 N COUNTRY CLUB DR
Practice Address - Street 2:728
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1733
Practice Address - Country:US
Practice Address - Phone:732-249-7654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-044317-E207ZB0001X
CAG070971207ZP0105X
FLMD-0076764207ZP0105X
AZ27131207ZP0105X
NJ722206207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
No207ZB0001XAllopathic & Osteopathic PhysiciansPathologyBlood Banking & Transfusion Medicine