Provider Demographics
NPI:1083684849
Name:JOHNSTON, DANA CHARLES (MD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:CHARLES
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN SQUARE
Mailing Address - State:NY
Mailing Address - Zip Code:11010-3636
Mailing Address - Country:US
Mailing Address - Phone:516-354-7100
Mailing Address - Fax:516-354-7160
Practice Address - Street 1:925 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:FRANKLIN SQUARE
Practice Address - State:NY
Practice Address - Zip Code:11010-3636
Practice Address - Country:US
Practice Address - Phone:516-354-7100
Practice Address - Fax:516-354-7160
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY142107207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00E031Medicare ID - Type Unspecified
NYC04428Medicare UPIN