1013984947 NPI number — BRIAN JOHNSON MD

Table of content: BRIAN JOHNSON MD (NPI 1013984947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013984947 NPI number — BRIAN JOHNSON MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
BRIAN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1013984947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1177
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTHAMPTON
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01061-1177
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-586-8443
Provider Business Mailing Address Fax Number:
413-582-8443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30 LOCUST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTHAMPTON
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01060-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-582-2105
Provider Business Practice Location Address Fax Number:
413-582-2059
Provider Enumeration Date:
02/28/2006

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: 207L00000X , with the licence number:  153887 , 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: 04-3364403 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 321917 . This is a "CONNECTICARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3364403 . This is a "CONSOLIDATED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 273698 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 812357 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3364403 . This is a "NORTH AMERICAN PREFERRED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 000000020117 . This is a "BMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3364403 . This is a "UNICARE/GIC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 20463 . This is a "HEALTH NEW ENGLAND" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 615492 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3364403 . This is a "NORTHEAST HEALTH DIRECT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 94881180001 . This is a "CIGNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3364403 . This is a "NORTHEAST HEALTHCARE ALLI" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3166856 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 04-3364403 . This is a "GREAT-WEST" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 04-3364403 . This is a "PLAN VISTA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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