Provider Demographics
NPI:1447267661
Name:JOHNSON, RENA MARIE (MD)
Entity type:Individual
Prefix:
First Name:RENA
Middle Name:MARIE
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 1:6230 OLD DOBBIN LN STE 230
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-5884
Mailing Address - Country:US
Mailing Address - Phone:410-730-3399
Mailing Address - Fax:443-709-8672
Practice Address - Street 1:6250 OLD DOBBIN LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-5816
Practice Address - Country:US
Practice Address - Phone:410-730-3399
Practice Address - Fax:443-709-8672
Is Sole Proprietor?:No
Enumeration Date:2006-08-01
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037270207Q00000X
VA0101840605207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD338822YVZMedicare PIN
MD338822ZDDBMedicare PIN
MD317269YWV2Medicare PIN