Healthcare Provider Details

I. General information

NPI: 1013984947
Provider Name (Legal Business Name): BRIAN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 05/01/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

30 LOCUST ST
NORTHAMPTON MA
01060-2052
US

IV. Provider business mailing address

PO BOX 1177
NORTHAMPTON MA
01061-1177
US

V. Phone/Fax

Practice location:
  • Phone: 413-582-2105
  • Fax: 413-582-2059
Mailing address:
  • Phone: 413-586-8443
  • Fax: 413-582-8443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number153887
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: