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NPI Code Detail

MEDICARE: DR. DAVID E JOHNSEN M.D.

MEDICARE: DR. DAVID E JOHNSEN 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
12085R0202XDiagnostic Radiology Physician0101046138VA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
15937781OTHERVAAETNA
210022537OTHERVAOPTIMA/SENTARA
35937781OTHERAETNA
4MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1215955976
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DAVID E JOHNSEN M.D.
Provider Business Mailing Address
First Line : 213 S JEFFERSON ST STE 1006
Second Line :
City : ROANOKE
State : VA
Zip : 24011-1713
Country : US
Telephone Number : 540-224-5516
Fax Number :
Provider Business Practice Location Address
First Line : 1906 BELLEVIEW AVE SE
Second Line :
City : ROANOKE
State : VA
Zip : 24014-1838
Country : US
Telephone Number : 540-981-7000
Fax Number : 540-981-8260
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/18/2006
Last Update Date : 06/01/2026

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