Provider Demographics
NPI:1972728459
Name:JOHNSON, CLARION ELLIS (MD)
Entity type:Individual
Prefix:DR
First Name:CLARION
Middle Name:ELLIS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5504 DORSET AVE
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6626
Mailing Address - Country:US
Mailing Address - Phone:301-907-3362
Mailing Address - Fax:
Practice Address - Street 1:3225 GALLOWS RD
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22037-0001
Practice Address - Country:US
Practice Address - Phone:703-846-4039
Practice Address - Fax:703-846-1547
Is Sole Proprietor?:No
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101042764174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist