MEDICARE: DR. WILLIAM GILL JOHNSON

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
1	207R00000X	Internal Medicine Physician	161045	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1992791420
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM GILL JOHNSON

Provider Business Mailing Address
First Line	:	18710 LINDEN BLVD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-4026
Country	:	US
Telephone Number	:	717-723-1769
Fax Number	:

Provider Business Practice Location Address
First Line	:	18710 LINDEN BLVD
Second Line	:
City	:	SAINT ALBANS
State	:	NY
Zip	:	11412-4026
Country	:	US
Telephone Number	:	717-723-1769
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/20/2005
Last Update Date	:	09/25/2012

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