Healthcare Provider Details

I. General information

NPI: 1144499526
Provider Name (Legal Business Name): PAUL R JOHNSON MDFACSPC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/29/2008
Last Update Date: 02/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 S CROSS ST SUITE 1
CHESTERTOWN MD
21620-4752
US

IV. Provider business mailing address

PO BOX 1079
CHESTERTOWN MD
21620-5079
US

V. Phone/Fax

Practice location:
  • Phone: 410-778-0088
  • Fax: 410-778-9592
Mailing address:
  • Phone: 410-778-0088
  • Fax: 410-778-9592

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. PAUL R JOHNSON
Title or Position: OWNER
Credential: M.D.
Phone: 410-778-0088