1467433342 NPI number — THOMAS JOHNSON MD

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

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	:	1467433342
Entity Type Code	:	Individual
Replacement NPI	:
Last Update Date	:	07/08/2007
NPI Deactivation Reason Code	:
NPI Deactivation Date	:
NPI Reactivation Date	:

Provider First Line Business Mailing Address	:	PO BOX 9135
Provider Second Line Business Mailing Address	:	ATT:SHARON SILVA
Provider Business Mailing Address City Name	:	BROOKLINE
Provider Business Mailing Address State Name	:	MA
Provider Business Mailing Address Postal Code	:	024469135
Provider Business Mailing Address Country Code	:	US
Provider Business Mailing Address Telephone Number	:	8009270002
Provider Business Mailing Address Fax Number	:

Provider First Line Business Practice Location Address	:	300 LONGWOOD AVE
Provider Second Line Business Practice Location Address	:
Provider Business Practice Location Address City Name	:	BOSTON
Provider Business Practice Location Address State Name	:	MA
Provider Business Practice Location Address Postal Code	:	021155724
Provider Business Practice Location Address Country Code	:	US
Provider Business Practice Location Address Telephone Number	:	6173558876
Provider Business Practice Location Address Fax Number	:
Provider Enumeration Date	:	11/08/2005

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

• Taxonomy code: 2080P0202X , with the licence number:  12135 , registered in the state of NH .
• Taxonomy code: 174400000X , with the licence number: 223207 , registered in the state of MA .

• Identifier: A38495 , issued by the state of ( MA ) . This identifiers is of the category "".
• Identifier: E55136 . This identifiers is of the category "".
• Identifier: 2104067 , issued by the state of ( MA ) . This identifiers is of the category "".