Healthcare Provider Details

I. General information

NPI: 1770770604
Provider Name (Legal Business Name): FABIAN MCCARTNEY JOHNSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/25/2007
Last Update Date: 05/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N WOLFE ST BLALOCK 685
BALTIMORE MD
21287-0005
US

IV. Provider business mailing address

600 N WOLFE ST BLALOCK 685
BALTIMORE MD
21287-0005
US

V. Phone/Fax

Practice location:
  • Phone: 410-502-2846
  • Fax: 443-451-8583
Mailing address:
  • Phone: 410-502-2846
  • Fax: 443-451-8583

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberMD.200665
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number2007016513
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License Number61018
License Number StateWI
# 4
Primary TaxonomyY
Taxonomy Code2086X0206X
TaxonomySurgical Oncology Physician
License NumberD0071814
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: