Healthcare Provider Details

I. General information

NPI: 1821192535
Provider Name (Legal Business Name): ERIC E JOHNSON MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2006
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 RESNIK RD SUITE 202
PLYMOUTH MA
02360
US

IV. Provider business mailing address

45 RESNIK RD SUITE 202
PLYMOUTH MA
02360
US

V. Phone/Fax

Practice location:
  • Phone: 508-746-0754
  • Fax: 508-747-7867
Mailing address:
  • Phone: 508-746-0754
  • Fax: 508-747-7867

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ERIC E JOHNSON
Title or Position: PRESIDENT
Credential: MD
Phone: 508-746-0754