1033300728 NPI number — DR. MARIA ELENA JOHNSON M.D.

Table of content: DR. MARIA ELENA JOHNSON M.D. (NPI 1033300728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033300728 NPI number — DR. MARIA ELENA JOHNSON M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
JOHNSON
Provider First Name:
MARIA
Provider Middle Name:
ELENA
Provider Name Prefix Text:
DR.
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:
SORIANO
Provider Other First Name:
MARIA
Provider Other Middle Name:
ELENA
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1033300728
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/01/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
85 SEYMOUR ST
Provider Second Line Business Mailing Address:
SUITE 1000
Provider Business Mailing Address City Name:
HARTFORD
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06106-5501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-246-2571
Provider Business Mailing Address Fax Number:
860-246-3691

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
85 SEYMOUR ST
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
HARTFORD
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06106-5501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-246-2571
Provider Business Practice Location Address Fax Number:
860-246-3691
Provider Enumeration Date:
08/07/2007

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: 207RG0100X , with the licence number:  048571 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 008040276 , issued by the state of ( CT ) . This identifiers is of the category "MEDICAID".




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