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NPI Code Detail

MEDICARE: MICHAEL DAVID JOHNSON PAC

MEDICARE: MICHAEL DAVID JOHNSON PAC
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
1363A00000XPhysician Assistant

General Provider Information

NPI Number : 1215128970
Entity Type Code : Individual
Provider Name (Legal Business Name) : MICHAEL DAVID JOHNSON PAC
Provider Business Mailing Address
First Line : 101 HOSPITAL CENTER BLVD
Second Line :
City : STAFFORD
State : VA
Zip : 22554-6200
Country : US
Telephone Number : 703-547-7617
Fax Number :
Provider Business Practice Location Address
First Line : 101 HOSPITAL CENTER BLVD
Second Line :
City : STAFFORD
State : VA
Zip : 22554-6200
Country : US
Telephone Number : 703-547-7617
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/07/2007
Last Update Date : 09/17/2015

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Directions to “ MICHAEL DAVID JOHNSON PAC” Practice Location

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