Provider Demographics
NPI:1598119802
Name:JOHNSON, MAGGIE SULLIVAN (MD)
Entity type:Individual
Prefix:DR
First Name:MAGGIE
Middle Name:SULLIVAN
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 1:20 DOROTHY E LUCEY DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-1781
Mailing Address - Country:US
Mailing Address - Phone:413-204-1656
Mailing Address - Fax:
Practice Address - Street 1:414 HAVERHILL ST
Practice Address - Street 2:
Practice Address - City:ROWLEY
Practice Address - State:MA
Practice Address - Zip Code:01969-1919
Practice Address - Country:US
Practice Address - Phone:877-379-5522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA278377207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty