Provider Demographics
NPI:1861616922
Name:JOHNSON, ANDRE H (MD)
Entity type:Individual
Prefix:DR
First Name:ANDRE
Middle Name:H
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 1:121 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12205-1474
Mailing Address - Country:US
Mailing Address - Phone:518-489-2663
Mailing Address - Fax:
Practice Address - Street 1:14 HUDSON AVE
Practice Address - Street 2:
Practice Address - City:GLENS FALLS
Practice Address - State:NY
Practice Address - Zip Code:12801-4448
Practice Address - Country:US
Practice Address - Phone:518-926-5600
Practice Address - Fax:518-926-5605
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2025-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY243460207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02898593Medicaid
NY243460-3WOtherNYS WORKERS' COMP
NYRB4301Medicare PIN