Provider Demographics
NPI:1932179421
Name:JOHNSON, THOMAS V (DPM)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:V
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1379 ENFIELD ST
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5524
Mailing Address - Country:US
Mailing Address - Phone:860-741-3041
Mailing Address - Fax:860-741-5644
Practice Address - Street 1:1379 ENFIELD ST
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5524
Practice Address - Country:US
Practice Address - Phone:860-741-3041
Practice Address - Fax:860-741-5644
Is Sole Proprietor?:No
Enumeration Date:2006-01-25
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTP00373213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
0V0651OtherHEALTHNET
030000373CT02OtherANTHEM
HAS372OtherOXFORD
0453607-001OtherCIGNA
4138298OtherAETNA
CT0005060OtherTRICARE
060373OtherCONNECTICARE
0453607-001OtherCIGNA
CT0005060OtherTRICARE