Healthcare Provider Details

I. General information

NPI: 1104878065
Provider Name (Legal Business Name): PAMELA CAROL JOHNSON MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 05/19/2026
Certification Date: 05/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8500 ANNAPOLIS RD STE 200
NEW CARROLLTON MD
20784-3022
US

IV. Provider business mailing address

8500 ANNAPOLIS RD STE 200
NEW CARROLLTON MD
20784-3022
US

V. Phone/Fax

Practice location:
  • Phone: 202-531-5033
  • Fax:
Mailing address:
  • Phone: 202-531-5033
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberD44855
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101237027
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101237027
License Number StateVA
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD047674
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: