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General NPI Number Information
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NPI Number | 1588161608
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Entity Type | Organization
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Legal Business Name | MICHAEL P. JOHNSON, MD, INC
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Dates
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Enumeration Date | 04/06/2018
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Last Update Date | 04/29/2022
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Provider Practice Location Address
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Address Line | 148 W RIVER ST STE 22B
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City | PROVIDENCE
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State | RI
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Zip | 02904
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Country | US
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Telephone | 401-521-7100
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Fax | 401-521-7102
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Provider Business Mailing Address
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Address Line | 148 W RIVER ST STE 22B
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City | PROVIDENCE
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State | RI
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Zip | 02904-2628
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Country | US
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Telephone | 401-521-7100
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Fax | 401-521-7102
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | DR. CARLA M. MARTIN
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Credential | MD
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Telephone | 401-521-7100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD09266
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License Number State | RI
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