Johnson, Derek K
Johnson, Derek K is an sole proprietor health care provider with primary practice located at 3903A Fair Ridge Dr , Fairfax VA 22033-2938. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology, which is considered as his primary health care specialty. Johnson, Derek K can be contacted via phone (703) 648-0030.Contact Information
Primary practice address
3903A Fair Ridge Dr
Fairfax VA 22033-2938
Phone: (703) 648-0030
Fax: (703) 648-9028
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatric Allergy/Immunology | 2080P0201X | MD 065160L | Pennsylvania |
Profile Details
| NPI number | 1285622183 |
|---|---|
| LBN Legal business name | Johnson, Derek K |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 13th, 2005 |
| Last updated | Feb 27th, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1285622183 | NPPES |
| Pennsylvania | MEDICAID | 0018751530003 |
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