Provider Demographics
NPI:1124061742
Name:JOHNSON-ARBOR, KELLY K (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:K
Last Name:JOHNSON-ARBOR
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 1:3800 RESERVOIR RD NW
Mailing Address - Street 2:BLES BUILDING 1ST FLOOR
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20007-2113
Mailing Address - Country:US
Mailing Address - Phone:202-444-3059
Mailing Address - Fax:202-444-2130
Practice Address - Street 1:3800 RESERVOIR RD NW
Practice Address - Street 2:BLES BUILDING, FIRST FLOOR
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20007-2113
Practice Address - Country:US
Practice Address - Phone:202-444-3059
Practice Address - Fax:202-444-2130
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2019-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD043120207PT0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207PT0002XAllopathic & Osteopathic PhysiciansEmergency MedicineMedical Toxicology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC094517600Medicaid
MD954132200Medicaid
CT001424472Medicaid
DC094517600Medicaid
CT930001223 (C00814)Medicare PIN
433586YT2Medicare PIN