Provider Demographics
NPI:1366422677
Name:JOHNSON, GREGORY (MD)
Entity type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:
Last Name:JOHNSON
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 1:1 RECOVERY RD
Mailing Address - Street 2:
Mailing Address - City:WAREHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02571-5011
Mailing Address - Country:US
Mailing Address - Phone:508-295-5100
Mailing Address - Fax:508-295-9467
Practice Address - Street 1:1 RECOVERY RD
Practice Address - Street 2:
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02571-5011
Practice Address - Country:US
Practice Address - Phone:508-295-5100
Practice Address - Fax:508-295-9467
Is Sole Proprietor?:No
Enumeration Date:2006-01-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA40750207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2056283Medicaid
MA17022OtherHARVARD PILGRIM HEALTHCAR
MA000000023729OtherBOSTON MEDICAL CENTER HEA
MA28592OtherCHILDRENS MEDICAL SECURIT
MA766401OtherTUFTS HEALTH PLAN
MAB20436401OtherCIGNA
MAB33524OtherBCBS OF MASSACHUSETTS
MA0018476OtherNEIGHBORHOOD HEALTH PLAN
MA09-00266OtherUNITEDHEALTHCARE
MA0563550OtherAETNA/US HEALTHCARE
MA2056283Medicaid
MA0563550OtherAETNA/US HEALTHCARE