Provider Demographics
NPI:1952326548
Name:JOHNSON, GAYLEN S (MD)
Entity Type:Individual
Prefix:DR
First Name:GAYLEN
Middle Name:S
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 1:10715 DOWNSVILLE PIKE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-7240
Mailing Address - Country:US
Mailing Address - Phone:240-313-9910
Mailing Address - Fax:240-313-9915
Practice Address - Street 1:10715 DOWNSVILLE PIKE
Practice Address - Street 2:SUITE 100
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-7240
Practice Address - Country:US
Practice Address - Phone:240-313-9910
Practice Address - Fax:240-313-9915
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2013-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD547112083A0100X, 2083X0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational Medicine
No2083A0100XAllopathic & Osteopathic PhysiciansPreventive MedicineAerospace Medicine