Individual ProviderMelvin Russell JohnsonInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address4001 Coliseum Dr, Ste 310, Hampton, VA 23666-6257(757) 827-2025PECOS EnrollmentBased on the most recent information from CMS, provider Melvin Russell Johnson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1568497675Provider TypeIndividualFull NameJohnson, Melvin RussellTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date7/11/2006Last Updated2/29/2012Contact InformationPractice LocationPractice Address4001 Coliseum Dr, Ste 310, Hampton, VA 23666-6257Phone(757) 827-2025Fax(757) 275-9802Mailing LocationMailing Address4001 Coliseum Dr, Ste 310, Hampton, VA 23666-6257Phone(757) 827-2025Fax(757) 275-9802Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense0101-030884VirginiaProvider IdentifiersIDDescriptionIssuerID6009654DescriptionMedicaidIssuerUnlistedVirginia