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General NPI Number Information
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NPI Number | 1033672662
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Entity Type | Individual
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Provider Name | ABBY RACHEL ROSENBERG JOHNSON MD
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Gender | Female
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Dates
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Enumeration Date | 04/10/2019
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Last Update Date | 10/23/2023
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Provider Practice Location Address
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Address Line | 8000 MARYLAND AVE STE 760
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City | CLAYTON
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State | MO
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Zip | 63105-3752
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Country | US
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Telephone | 314-474-0114
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Fax |
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Provider Business Mailing Address
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Address Line | 8000 MARYLAND AVE STE 760
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City | CLAYTON
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State | MO
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Zip | 63105-3752
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Country | US
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Telephone | 314-474-0114
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number | 2023037139
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License Number State | MO
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