Healthcare Provider Details

I. General information

NPI: 1881670958
Provider Name (Legal Business Name): MARY DEIRDRE JOHNSTON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 09/18/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE STREET JOHNS HOPKINS UNIVERSITY SCHOOL OF MEDICINE
BALTIMORE MD
21287-7279
US

IV. Provider business mailing address

9910 FRANKLIN SQUARE DRIVE SUITE 2110 JOHNS HOPKINS UNIVERSITY REIMBURSEMENT COORDINATOR
WHITE MARSH MD
21236-4902
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-5147
  • Fax:
Mailing address:
  • Phone: 410-933-2718
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0805X
TaxonomyGeriatric Psychiatry Physician
License Number9500105
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: