1831204122 NPI number — MICHELE JOHNSON M.D.

Table of content: MICHELE JOHNSON M.D. (NPI 1831204122)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831204122 NPI number — MICHELE JOHNSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
MICHELE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831204122
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 71
Provider Second Line Business Mailing Address:
C/O KDC MANAGEMENT
Provider Business Mailing Address City Name:
TEWKSBURY
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01876-0071
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
978-657-5866
Provider Business Mailing Address Fax Number:
978-657-5877

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
60 EAST ST
Provider Second Line Business Practice Location Address:
SUITE 3300
Provider Business Practice Location Address City Name:
METHUEN
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01844-4500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
978-685-3440
Provider Business Practice Location Address Fax Number:
978-657-5877
Provider Enumeration Date:
08/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  49865 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01Y005533MA01 . This is a "ANTHEM" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 30008466 . This is a "MEDICAID NH GROUP" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 708116 . This is a "TUFTS INDIV.NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 6967 . This is a "FALLON" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: D13217 . This is a "BC/BS INDIVIDUAL #" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: NEIGHBORHOOD HEALTH . This is a "1801562" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 98207101 . This is a "NETWORK INDIV NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 0173096 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1309662 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 30205174 . This is a "MEDICAID OF NH INDIV" identifier , issued by the state of ( NH ) . This identifiers is of the category "OTHER".
  • Identifier: 13307 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 51762 . This is a "FALLON GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 978403 . This is a "NETWORK GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 611003 . This is a "TUFTS GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: M17489 . This is a "BC/BS GROUP NUMBER" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 9787143 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".




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