Healthcare Provider Details

I. General information

NPI: 1366482044
Provider Name (Legal Business Name): ROBERT M. JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/08/2006
Last Update Date: 04/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 PLEASANT STREET
CONCORD NH
03301
US

IV. Provider business mailing address

60 COMMERCIAL ST SUITE 401
CONCORD NH
03301-5071
US

V. Phone/Fax

Practice location:
  • Phone: 603-228-7555
  • Fax: 603-415-9470
Mailing address:
  • Phone: 603-228-7555
  • Fax: 603-415-9470

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number5779
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: