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General NPI Number Information
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NPI Number | 1942473186
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Entity Type | Individual
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Provider Name | DERRICK JEROD JOHNSON MS
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Gender | Male
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Dates
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Enumeration Date | 04/09/2008
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Last Update Date | 07/16/2009
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Provider Practice Location Address
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Address Line | 7601 MATAPEAKE BUSINESS DRIVE
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City | BRANDYWINE
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State | MD
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Zip | 20613
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Country | US
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Telephone | 301-758-6857
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 739
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City | COLLEGE PARK
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State | MD
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Zip | 20741-0739
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Country | US
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Telephone | 301-758-6857
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 1147
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License Number State | MD
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