Provider Demographics
NPI:1316099187
Name:JOHNSON, ALEXANDER (CP CERTIFIED PROSTHE)
Entity type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:CP CERTIFIED PROSTHE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:66 SEEKONK CROSSROAD
Mailing Address - Street 2:
Mailing Address - City:GREAT BARRINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01230-1569
Mailing Address - Country:US
Mailing Address - Phone:413-528-3562
Mailing Address - Fax:
Practice Address - Street 1:99 FIRST ST
Practice Address - Street 2:BERKSHIRE PROSTHETIC CENTER
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4745
Practice Address - Country:US
Practice Address - Phone:413-442-5381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
P1026225000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225000000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotic Fitter
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1524631Medicaid
MA1524631Medicaid