MEDICARE: DR. JAMES A JOHNSEN MD

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	208100000X	Physical Medicine & Rehabilitation Physician	0101045781	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1710955265
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES A JOHNSEN MD

Provider Business Mailing Address
First Line	:	5520 CHEROKEE AVE
Second Line	:	SUITE 215
City	:	ALEXANDRIA
State	:	VA
Zip	:	22312-2319
Country	:	US
Telephone Number	:	703-914-8000
Fax Number	:	703-642-3487

Provider Business Practice Location Address
First Line	:	2800 S SHIRLINGTON RD
Second Line	:	SUITE 102
City	:	ARLINGTON
State	:	VA
Zip	:	22206-3601
Country	:	US
Telephone Number	:	703-914-8000
Fax Number	:	703-642-3487

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

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	07/08/2007

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