Provider Demographics
NPI:1063458107
Name:JOHNSON, ALEDA NASH (MD)
Entity type:Individual
Prefix:
First Name:ALEDA
Middle Name:NASH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:ALEDA
Other - Middle Name:CHARRISE
Other - Last Name:NASH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:6201 GREENLEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:410-933-0000
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:12916 CONAMAR DR STE 204
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742-2773
Practice Address - Country:US
Practice Address - Phone:410-955-6666
Practice Address - Fax:410-367-2023
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2025-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0104061207Q00000X
OH35082882J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2444975Medicaid
OHH223810Medicare PIN
OH2444975Medicaid