Provider Demographics
NPI:1255539037
Name:JOHNSON, SARAH ANNE (MD)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:ANNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SARAH
Other - Middle Name:ANNE
Other - Last Name:RUSSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:41680 MISS BESSIE DR
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-2906
Mailing Address - Country:US
Mailing Address - Phone:301-997-0055
Mailing Address - Fax:301-997-0066
Practice Address - Street 1:41680 MISS BESSIE DR
Practice Address - Street 2:SUITE 301
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650-2906
Practice Address - Country:US
Practice Address - Phone:301-997-0055
Practice Address - Fax:301-997-0066
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2012-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116019252390200000X
MDD71807207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics