Healthcare Provider Details

I. General information

NPI: 1467433342
Provider Name (Legal Business Name): THOMAS BRYAN JOHNSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 11/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

789 CENTRAL AVE 3RD FLOOR
DOVER NH
03820-2526
US

IV. Provider business mailing address

789 CENTRAL AVE 3RD FLOOR
DOVER NH
03820-2526
US

V. Phone/Fax

Practice location:
  • Phone: 603-740-2366
  • Fax:
Mailing address:
  • Phone: 603-740-2366
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number223207
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code2080P0202X
TaxonomyPediatric Cardiology Physician
License Number12135
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: