Healthcare Provider Details

I. General information

NPI: 1245212471
Provider Name (Legal Business Name): DAVID L JOHNSTON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/15/2005
Last Update Date: 09/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

158 DANBURY RD STE 6
RIDGEFIELD CT
06877-3227
US

IV. Provider business mailing address

158 DANBURY RD STE 6
RIDGEFIELD CT
06877-3227
US

V. Phone/Fax

Practice location:
  • Phone: 203-438-9915
  • Fax: 203-431-4410
Mailing address:
  • Phone: 203-438-9915
  • Fax: 203-431-4410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number000523
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: