Provider Demographics
NPI:1992729834
Name:JOHNSON, PETER B (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:B
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 1:19 STURDY ST
Mailing Address - Street 2:
Mailing Address - City:ATTLEBORO
Mailing Address - State:MA
Mailing Address - Zip Code:02703-3152
Mailing Address - Country:US
Mailing Address - Phone:508-236-8350
Mailing Address - Fax:508-236-8377
Practice Address - Street 1:19 STURDY ST
Practice Address - Street 2:
Practice Address - City:ATTLEBORO
Practice Address - State:MA
Practice Address - Zip Code:02703-3152
Practice Address - Country:US
Practice Address - Phone:508-236-8350
Practice Address - Fax:508-236-8377
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA53868207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
004245OtherRIBCHIP
000000028122OtherBMC HEALTHNET
702719OtherTUFTS
6690OtherHPHC
0402003OtherUHC
MAJ04227OtherMABC
MA3084051Medicaid
1189OtherFALLON
B10040001OtherCIGNA
1189OtherFALLON
MAJ04227OtherMABC