Healthcare Provider Details

I. General information

NPI: 1194928689
Provider Name (Legal Business Name): ROBERT MERLE JOHNSTON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/11/2007
Last Update Date: 08/28/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 WAVERLY ST ADVOCATES INC.
FRAMINGHAM MA
01702-7079
US

IV. Provider business mailing address

354 WAVERLY ST. ADVOCATES INC.
FRAMINGHAM MA
01702
US

V. Phone/Fax

Practice location:
  • Phone: 508-661-2020
  • Fax:
Mailing address:
  • Phone: 508-661-2020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number253118
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: