Johnson, Mark Leo
Johnson, Mark Leo is an individual health care provider with primary practice located at 3000 Mon Health Medical Park Dr Ste 3300 , Morgantown WV 26505-1169. He recently has only one registered license in Allopathic & Osteopathic Physicians / Surgery, which is considered as his primary health care specialty. Johnson, Mark Leo can be contacted via phone (304) 599-1448.Contact Information
Primary practice address
3000 Mon Health Medical Park Dr Ste 3300
Morgantown WV 26505-1169
Phone: (304) 599-1448
Fax: (304) 599-5335
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Surgery | 208600000X | 18363 | West Virginia |
Profile Details
| NPI number | 1649353855 |
|---|---|
| LBN Legal business name | Johnson, Mark Leo |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 23rd, 2006 |
| Last updated | Apr 1st, 2024 - about last year |
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 | 1649353855 | NPPES |
| West Virginia | Other | WV5186C185 | MEDICARE |
| West Virginia | Other | 001719640 | MEDICARE |
| West Virginia | MEDICAID | 0126399000 | MEDICARE |
| West Virginia | Other | PO1453582 | MEDICARE |
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