Basic Information
| Provider Information | |||||||||
| NPI: | 1285707018 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | KAREN | ||||||||
| MiddleName: | E | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2000 NORTH BEAUREGARD ST | ||||||||
| Address2: | STE 360 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039249004 | ||||||||
| FaxNumber: | 7039249067 | ||||||||
| Practice Location | |||||||||
| Address1: | 2000 NORTH BEAUREGARD ST | ||||||||
| Address2: | STE 360 | ||||||||
| City: | ALEXANDRIA | ||||||||
| State: | VA | ||||||||
| PostalCode: | 22311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7039249004 | ||||||||
| FaxNumber: | 7039249067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/17/2006 | ||||||||
| LastUpdateDate: | 05/12/2014 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0200X | 0101054749 | VA | N | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | 207RP1001X | 0101054749 | VA | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
ID Information
| ID | Type | State | Issuer | Description | 010188946 | 05 | VA | MEDICAID |