Healthcare Provider Details

I. General information

NPI: 1619990744
Provider Name (Legal Business Name): MARY JOHANNA JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY JOHANNA GUTBERLET MD

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

185 HARRY S TRUMAN PKWY STE 120
ANNAPOLIS MD
21401-7580
US

IV. Provider business mailing address

PO BOX 12622
BELFAST ME
04915-4017
US

V. Phone/Fax

Practice location:
  • Phone: 410-224-4442
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberMD435925
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberD35702
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: