Provider Demographics
NPI:1700809035
Name:JOHNSON, MATRIKA D (MD)
Entity Type:Individual
Prefix:DR
First Name:MATRIKA
Middle Name:D
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 1:3208 DEXTER ST
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28209-1905
Mailing Address - Country:US
Mailing Address - Phone:216-509-0023
Mailing Address - Fax:704-247-2210
Practice Address - Street 1:1918 RANDOLPH RD STE 210
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1109
Practice Address - Country:US
Practice Address - Phone:704-247-2209
Practice Address - Fax:704-247-2210
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2020-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2015-01288207VE0102X
PAMD444722207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology