Provider Demographics
NPI:1245292853
Name:JOHNSON, AMY S (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:S
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 1:305 10TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:POCOMOKE
Mailing Address - State:MD
Mailing Address - Zip Code:21851-1607
Mailing Address - Country:US
Mailing Address - Phone:410-957-3005
Mailing Address - Fax:410-957-0550
Practice Address - Street 1:305 10TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:POCOMOKE
Practice Address - State:MD
Practice Address - Zip Code:21851-1607
Practice Address - Country:US
Practice Address - Phone:410-957-3005
Practice Address - Fax:410-957-0550
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0058928207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA245973OtherPROVIDER NO.
MD181482OtherPROVIDER NO.
MD61721001OtherPROVIDER NO.
MD877172OtherPROVIDER NO.
MDF094 0007OtherPROVIDER NO.
MD61721001OtherPROVIDER NO.