Doctor Name: | DR. RUSSELL G JOHNSTON |
NPI Number: | 1790845493 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | 0101028362 |
Business Practice Address: | Prince William Hospital 8700 Sudley Road Manassas, VA - 200114418 |
Business Phone Number: | 7033798000 |
Business Fax Number: | |
Mailing Address: | 17390 Berkshire Dr, JEFFERSONTON |
State: | VA |
Postal Code: | 227241702 |
Phone Number: | 5409373969 |
Fax Number: | |
NPI Enumeration Date: | 12/11/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 174400000X |
License Number: | 0101028362 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | VA |
Taxonomy Type: | Other Service Providers |
Taxonomy Classification: | Specialist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. |