Provider Demographics
NPI:1528846839
Name:JOHNSON, MARK ANTON
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:ANTON
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 2ND ST NW # 2N
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2003
Mailing Address - Country:US
Mailing Address - Phone:202-783-7343
Mailing Address - Fax:202-347-5476
Practice Address - Street 1:425 2ND ST NW # 2N
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2003
Practice Address - Country:US
Practice Address - Phone:202-783-7343
Practice Address - Fax:202-347-5476
Is Sole Proprietor?:No
Enumeration Date:2023-09-18
Last Update Date:2023-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCCPRS0103175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist