Healthcare Provider Details

I. General information

NPI: 1760703904
Provider Name (Legal Business Name): ELLYN JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 14TH ST NW
WASHINGTON DC
20010-3402
US

IV. Provider business mailing address

3417 14TH ST NW
WASHINGTON DC
20010-3402
US

V. Phone/Fax

Practice location:
  • Phone: 301-857-9333
  • Fax: 301-245-2733
Mailing address:
  • Phone: 301-857-9333
  • Fax: 301-245-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD210002381
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0101278206
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number86844
License Number StateSC
# 4
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD0094395
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: