Provider Demographics
NPI:1194946095
Name:JOHNSTON, PETER SHAY (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:SHAY
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 1:23000 MOAKLEY STREET
Mailing Address - Street 2:SUITE 102
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650
Mailing Address - Country:US
Mailing Address - Phone:301-475-5555
Mailing Address - Fax:301-475-8535
Practice Address - Street 1:23000 MOAKLEY STREET
Practice Address - Street 2:SUITE 102
Practice Address - City:LEONARDTOWN
Practice Address - State:MD
Practice Address - Zip Code:20650
Practice Address - Country:US
Practice Address - Phone:301-475-5555
Practice Address - Fax:301-475-8535
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2013-05-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0072342207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery