MEDICARE: AMY S. 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	207Q00000X	Family Medicine Physician	D0058928	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	245973	OTHER	VA	PROVIDER NO.
2	181482	OTHER	MD	PROVIDER NO.
3	61721001	OTHER	MD	PROVIDER NO.
4	877172	OTHER	MD	PROVIDER NO.
5	F094 0007	OTHER	MD	PROVIDER NO.

General Provider Information

NPI Number	:	1245292853
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY S. JOHNSON M.D.

Provider Business Mailing Address
First Line	:	305 10TH ST
Second Line	:	SUITE 101
City	:	POCOMOKE
State	:	MD
Zip	:	21851-1607
Country	:	US
Telephone Number	:	410-957-3005
Fax Number	:	410-957-0550

Provider Business Practice Location Address
First Line	:	305 10TH ST
Second Line	:	SUITE 101
City	:	POCOMOKE
State	:	MD
Zip	:	21851-1607
Country	:	US
Telephone Number	:	410-957-3005
Fax Number	:	410-957-0550

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

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	07/09/2007

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Directions to “ AMY S. JOHNSON M.D.” Practice Location

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