Provider Demographics
NPI:1952558322
Name:JOHNSON, LYNELLE TERESA (MD)
Entity type:Individual
Prefix:DR
First Name:LYNELLE
Middle Name:TERESA
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 1:3500 CLAY PL NE
Mailing Address - Street 2:ONE
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-2647
Mailing Address - Country:US
Mailing Address - Phone:202-306-2086
Mailing Address - Fax:
Practice Address - Street 1:3500 CLAY PL NE
Practice Address - Street 2:ONE
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-2647
Practice Address - Country:US
Practice Address - Phone:202-306-2086
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-27
Last Update Date:2017-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD037460207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC024905300Medicaid