Healthcare Provider Details

I. General information

NPI: 1114926565
Provider Name (Legal Business Name): LYNT JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 05/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 K ST NW STE 800
WASHINGTON DC
20037
US

IV. Provider business mailing address

2131 K ST NW STE 800
WASHINGTON DC
20037-1888
US

V. Phone/Fax

Practice location:
  • Phone: 202-715-5168
  • Fax: 202-715-4663
Mailing address:
  • Phone: 202-715-5168
  • Fax: 202-715-4663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204F00000X
TaxonomyTransplant Surgery Physician
License Number30759
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: