Healthcare Provider Details

I. General information

NPI: 1194702662
Provider Name (Legal Business Name): JEANNE M JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2005
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 S RIVER RD SUITE 100
BEDFORD NH
03110-6927
US

IV. Provider business mailing address

160 S RIVER RD SUITE 100
BEDFORD NH
03110-6927
US

V. Phone/Fax

Practice location:
  • Phone: 603-647-0494
  • Fax: 603-647-0493
Mailing address:
  • Phone: 603-647-0494
  • Fax: 603-647-0493

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number8779
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: