Healthcare Provider Details

I. General information

NPI: 1306975792
Provider Name (Legal Business Name): MEREDITH A. JOHNSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/03/2007
Last Update Date: 12/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

421 FALLSWAY HEALTH CARE FOR THE HOMELESS
BALTIMORE MD
21202
US

IV. Provider business mailing address

421 FALLSWAY HEALTH CARE FOR THE HOMELESS
BALTIMORE MD
21202
US

V. Phone/Fax

Practice location:
  • Phone: 410-837-5533
  • Fax: 410-837-2168
Mailing address:
  • Phone: 443-703-1106
  • Fax: 410-837-2168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberD62422
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: