Provider Demographics
NPI:1801933007
Name:JOHNSON, ZELDA WEST (MD)
Entity type:Individual
Prefix:DR
First Name:ZELDA
Middle Name:WEST
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 1:4101 DOMINION BLVD
Mailing Address - Street 2:STE 300
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-3457
Mailing Address - Country:US
Mailing Address - Phone:804-644-5440
Mailing Address - Fax:804-497-3397
Practice Address - Street 1:4101 DOMINION BLVD
Practice Address - Street 2:
Practice Address - City:GLEN ALLEN
Practice Address - State:VA
Practice Address - Zip Code:23060-3457
Practice Address - Country:US
Practice Address - Phone:804-908-3489
Practice Address - Fax:804-232-1592
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101057120207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA005602912Medicaid
VA453771OtherBC/BS OF VA
VA259227OtherBC/BS OF VA
VA259227OtherBC/BS OF VA
VA00V883D01Medicare PIN