Provider Demographics
NPI:1295715969
Name:JOHNSON, WILLIAM B (MD)
Entity type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:B
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 1:4532 PLANK RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22407-0139
Mailing Address - Country:US
Mailing Address - Phone:540-252-1840
Mailing Address - Fax:540-252-1841
Practice Address - Street 1:4532 PLANK RD
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22407-0139
Practice Address - Country:US
Practice Address - Phone:540-252-1840
Practice Address - Fax:540-252-1841
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2019-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236688208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VACO2375OtherMEDICARE GROUP
VA146228OtherANTHEM
VA3681738OtherAETNA HMO
VACA9037OtherMCR RAILROAD GROUP
VA010101476Medicaid
VA0101236688OtherLICENSE
VA000828306OtherAETNA CAP
VA0005614690OtherAETNA NON HMO
VA8129248OtherMAMSI
VACA9037OtherMCR RAILROAD GROUP
VA006647P75Medicare PIN