Provider Demographics
NPI:1104067180
Name:JOHNSON, REBECCA LYNNE (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNNE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 LONGWOOD DRIVE
Mailing Address - Street 2:P.O. BOX 1807
Mailing Address - City:GRANTHAM
Mailing Address - State:NH
Mailing Address - Zip Code:03753
Mailing Address - Country:US
Mailing Address - Phone:603-863-1055
Mailing Address - Fax:
Practice Address - Street 1:7 LONGWOOD DRIVE
Practice Address - Street 2:
Practice Address - City:GRANTHAM
Practice Address - State:NH
Practice Address - Zip Code:03753
Practice Address - Country:US
Practice Address - Phone:603-863-1055
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-20
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH115382084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry