MEDICARE: DR. ROBERT ALBERT JOHNSON M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	0101027024	VA

General Provider Information

NPI Number	:	1043234925
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ROBERT ALBERT JOHNSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 61094
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23466-1094
Country	:	US
Telephone Number	:	757-499-4949
Fax Number	:	757-499-0648

Provider Business Practice Location Address
First Line	:	293 INDEPENDENCE BLVD
Second Line	:	PEMBROKE FIVE, SUITE 330
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-5466
Country	:	US
Telephone Number	:	757-499-4949
Fax Number	:	757-499-0648

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/26/2006
Last Update Date	:	07/08/2007

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