Healthcare Provider Details

I. General information

NPI: 1710365788
Provider Name (Legal Business Name): NEAL JOHNSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 07/26/2022
Certification Date: 07/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

630 E RIVER ST STE 403
ELYRIA OH
44035-5902
US

IV. Provider business mailing address

630 E RIVER ST STE 403
ELYRIA OH
44035-5902
US

V. Phone/Fax

Practice location:
  • Phone: 240-686-2300
  • Fax:
Mailing address:
  • Phone: 240-686-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number35.137626
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberTL-50324
License Number StateKY
# 3
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number35.137626
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: