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General NPI Number Information
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NPI Number | 1366498545
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Entity Type | Individual
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Provider Name | THOMAS MARK JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 04/09/2019
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Provider Practice Location Address
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Address Line | 200 EXECUTIVE CENTER PKWY SUITE 102
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City | FREDERICKSBURG
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State | VA
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Zip | 22401-3177
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Country | US
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Telephone | 540-654-5333
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Fax | 540-654-5334
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Provider Business Mailing Address
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Address Line | 7501 GREENWAY CENTER DR SUITE 300
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City | GREENBELT
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State | MD
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Zip | 20770-3514
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Country | US
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Telephone | 301-441-4577
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Fax | 301-474-4679
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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 | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | D0057684
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | 0101231064
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number | MD32823
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License Number State | DC
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Taxonomy #4
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | MD32823
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License Number State | DC
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Taxonomy #5
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Taxonomy Code | 207WX0107X
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Taxonomy Name | Retina Specialist (Ophthalmology) Physician
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License Number | D0057684
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License Number State | MD
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