Provider Demographics
NPI:1588125793
Name:JOHNSON, BRET (DO)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12501 PROSPERITY DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1647
Mailing Address - Country:US
Mailing Address - Phone:301-681-6730
Mailing Address - Fax:
Practice Address - Street 1:12501 PROSPERITY DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1647
Practice Address - Country:US
Practice Address - Phone:301-681-6730
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-29
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH967142080A0000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine