Healthcare Provider Details

I. General information

NPI: 1306021753
Provider Name (Legal Business Name): CRAIG JOHNSON PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 08/15/2024
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10614 RACETRACK ROAD
BERLIN MD
21811
US

IV. Provider business mailing address

10026 OLD OCEAN CITY BLVD BUILDING ONE
BERLIN MD
21811
US

V. Phone/Fax

Practice location:
  • Phone: 410-208-9761
  • Fax: 410-208-9764
Mailing address:
  • Phone: 410-641-0430
  • Fax: 410-641-3871

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberC0001907
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: