Provider Demographics
NPI:1427094663
Name:JOHNSON, REBECCA LYNN (MD)
Entity type:Individual
Prefix:DR
First Name:REBECCA
Middle Name:LYNN
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 NORTH ST
Mailing Address - Street 2:PATHOLOGY & CLINICAL LABS
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-4132
Mailing Address - Country:US
Mailing Address - Phone:413-447-2565
Mailing Address - Fax:413-447-2097
Practice Address - Street 1:725 NORTH ST
Practice Address - Street 2:PATHOLOGY & CLINICAL LABS
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-4132
Practice Address - Country:US
Practice Address - Phone:413-447-2565
Practice Address - Fax:413-447-2097
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA45390207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology