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General NPI Number Information
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NPI Number | 1801879762
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Entity Type | Individual
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Provider Name | TIMOTHY A JOHNSON M.D.
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Gender | Male
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Dates
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Enumeration Date | 11/23/2005
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Last Update Date | 04/10/2014
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Provider Practice Location Address
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Address Line | 271 CAREW STREET
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City | SPRINGFIELD
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State | MA
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Zip | 01104
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Country | US
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Telephone | 413-748-7370
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Fax | 413-748-7221
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Provider Business Mailing Address
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Address Line | 271 CAREW STREET
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City | SPRINGFIELD
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State | MA
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Zip | 01104
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Country | US
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Telephone | 413-748-7370
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Fax | 413-748-7221
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number | 220236
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License Number State | MA
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