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NPI Code Detail

MEDICARE: BENJAMIN DANIEL JOHNSON D.O.

MEDICARE: BENJAMIN DANIEL JOHNSON D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianA-1997-16NM
2390200000XStudent in an Organized Health Care Education/Training Program
3207R00000XInternal Medicine Physician032.0134101VT

General Provider Information

NPI Number : 1699111237
Entity Type Code : Individual
Provider Name (Legal Business Name) : BENJAMIN DANIEL JOHNSON D.O.
Provider Business Mailing Address
First Line : 115 PORTER DR
Second Line :
City : MIDDLEBURY
State : VT
Zip : 05753-8629
Country : US
Telephone Number : 802-388-4701
Fax Number :
Provider Business Practice Location Address
First Line : 115 PORTER DR
Second Line :
City : MIDDLEBURY
State : VT
Zip : 05753-8629
Country : US
Telephone Number : 802-388-4701
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/21/2013
Last Update Date : 08/03/2023

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