Healthcare Provider Details

I. General information

NPI: 1104878065
Provider Name (Legal Business Name): PAMELA CAROL JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 12/17/2021
Certification Date: 12/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3742 10TH ST NE
WASHINGTON DC
20017-1820
US

IV. Provider business mailing address

1924 BRUCE PL SE
WASHINGTON DC
20020-2852
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-0358
  • Fax:
Mailing address:
  • Phone: 202-531-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101237027
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD44855
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101237027
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD047674
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: