Provider Demographics
NPI:1962422162
Name:JOHNSON, MARIA LUISA (MD)
Entity type:Individual
Prefix:DR
First Name:MARIA
Middle Name:LUISA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 PILOT MEDICAL DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3400
Mailing Address - Country:US
Mailing Address - Phone:205-854-8084
Mailing Address - Fax:205-815-9341
Practice Address - Street 1:100 PILOT MEDICAL DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3400
Practice Address - Country:US
Practice Address - Phone:205-854-8084
Practice Address - Fax:205-815-9341
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALC73540207RP1001X
ALMD.13732207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51501675Medicaid
AL51501675Medicare ID - Type Unspecified
ALC73540Medicare UPIN