MEDICARE: DR. SPENCER FRY JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	17232	DC
2	2084P0800X	Psychiatry Physician	D051645	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063579779
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SPENCER FRY JOHNSON M.D.

Provider Business Mailing Address
First Line	:	11703 AMER CT
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-5953
Country	:	US
Telephone Number	:	301-282-8751
Fax Number	:

Provider Business Practice Location Address
First Line	:	4400 STAMP RD
Second Line	:	SUITE 314
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6716
Country	:	US
Telephone Number	:	301-702-0047
Fax Number	:	301-702-0841

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	12/10/2012

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