Provider Demographics
NPI:1386753556
Name:JOHNSON, AMY D (MD)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:D
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:370 FOUNCE CORNER ROAD
Mailing Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Mailing Address - City:NO. DARTMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02747
Mailing Address - Country:US
Mailing Address - Phone:508-985-2000
Mailing Address - Fax:508-985-2001
Practice Address - Street 1:43 HIGH STREET
Practice Address - Street 2:SOUTHCOAST PHYSICIAN SERVICES, INC.
Practice Address - City:WAREHAM
Practice Address - State:MA
Practice Address - Zip Code:02750
Practice Address - Country:US
Practice Address - Phone:508-961-5919
Practice Address - Fax:508-961-5916
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2008-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA44626207P00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02275OtherBCBSMA
MA2090686Medicaid
MAB74215Medicare UPIN
MAJ02275Medicare ID - Type Unspecified