Healthcare Provider Details

I. General information

NPI: 1417519190
Provider Name (Legal Business Name): RICHARD AARON MARTIN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2019
Last Update Date: 08/22/2025
Certification Date: 08/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 MEDICAL CENTER DRIVE SUITE 3500
HUNTINGTON WV
25701-3655
US

IV. Provider business mailing address

1448 10TH AVENUE SUITE 304
HUNTINGTON WV
25701-3579
US

V. Phone/Fax

Practice location:
  • Phone: 304-691-1300
  • Fax: 304-691-1375
Mailing address:
  • Phone: 304-733-8728
  • Fax: 304-691-8591

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35444
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code2080P0203X
TaxonomyPediatric Critical Care Medicine Physician
License Number35444
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: