Provider Demographics
NPI:1346286788
Name:JOHNS, MARTIN C (MD)
Entity type:Individual
Prefix:
First Name:MARTIN
Middle Name:C
Last Name:JOHNS
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDOLPH
Mailing Address - State:VT
Mailing Address - Zip Code:05060-1381
Mailing Address - Country:US
Mailing Address - Phone:802-728-7000
Mailing Address - Fax:802-728-2394
Practice Address - Street 1:44 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDOLPH
Practice Address - State:VT
Practice Address - Zip Code:05060-1381
Practice Address - Country:US
Practice Address - Phone:802-728-7000
Practice Address - Fax:802-728-2394
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2025-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT042-0011092207R00000X, 208000000X
IL036.156385207R00000X
VT0420011092208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH01YP10147VT01OtherANTHEM BLUE CROSS
VT1012400Medicaid
VT5169188OtherCIGNA