Healthcare Provider Details

I. General information

NPI: 1942617147
Provider Name (Legal Business Name): DR. MARC C JOHNSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2014
Last Update Date: 08/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 N CAROLINE ST FL 6 DEPARTMENT OF OTOLARYNGOLOGY- HEAD AND NECK SURGERY
BALTIMORE MD
21287-0006
US

IV. Provider business mailing address

601 N CAROLINE ST FL 6 DEPARTMENT OF OTOLARYNGOLOGY- HEAD AND NECK SURGERY
BALTIMORE MD
21287-0006
US

V. Phone/Fax

Practice location:
  • Phone: 410-955-6153
  • Fax:
Mailing address:
  • Phone: 410-955-6153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number01350
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: