Provider Demographics
NPI:1588497192
Name:JOHNSON, KRISTINE HNATYSHYN (MD)
Entity type:Individual
Prefix:
First Name:KRISTINE
Middle Name:HNATYSHYN
Last Name:JOHNSON
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Gender:
Credentials:MD
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Other - Credentials:
Mailing Address - Street 1:C/O MICHELLE GUEVARA, DEPARTMENT OF ORTHOPEDICS & SPORT
Mailing Address - Street 2:300 LONGWOOD AVENUE BCH 3220
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115
Mailing Address - Country:US
Mailing Address - Phone:857-215-4924
Mailing Address - Fax:617-730-0459
Practice Address - Street 1:300 LONGWOOD AVENUE, BOSTON CHILDREN'S HOSPITAL
Practice Address - Street 2:MAILSTOP 3220
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115
Practice Address - Country:US
Practice Address - Phone:857-218-4924
Practice Address - Fax:617-730-0459
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-21
Last Update Date:2025-03-05
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Provider Licenses
StateLicense IDTaxonomies
MA3015971207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine