Healthcare Provider Details

I. General information

NPI: 1962602359
Provider Name (Legal Business Name): SANDRA CHRISTINE JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2007
Last Update Date: 10/27/2021
Certification Date: 10/27/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

80 SEYMOUR ST
HARTFORD CT
06102-5037
US

IV. Provider business mailing address

80 SEYMOUR STREET HARTFORD HOSPITAL EMERGENCY DEPT
HARTFORD CT
06102-5037
US

V. Phone/Fax

Practice location:
  • Phone: 860-545-0001
  • Fax:
Mailing address:
  • Phone: 860-545-0001
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207PP0204X
TaxonomyPediatric Emergency Medicine (Emergency Medicine) Physician
License Number047706
License Number StateCT
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number047706
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: