| Michael P. Johnson, Md, Inc | |
|
148 W River St Ste 22b Providence RI 02904 | |
| (401) 521-7100 | |
| (401) 521-7102 |
| Full Name | Michael P. Johnson, Md, Inc |
|---|---|
| Speciality | Internal Medicine |
| Location | 148 W River St Ste 22b, Providence, Rhode Island |
| Authorized Official Name and Position | Carla M. Martin (OFFICE MANAGER) |
| Authorized Official Contact | 4015217100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael P. Johnson, Md, Inc 148 W River St Ste 22b Providence RI 02904-2628 Ph: (401) 521-7100 | Michael P. Johnson, Md, Inc 148 W River St Ste 22b Providence RI 02904 Ph: (401) 521-7100 |
| NPI Number | 1588161608 |
|---|---|
| Provider Enumeration Date | 04/06/2018 |
| Last Update Date | 04/29/2022 |
| Medicare PECOS PAC ID | 2860756327 |
|---|---|
| Medicare Enrollment ID | O20180509000627 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1588161608 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | MD09266 (Rhode Island) | Primary |
| Provider Name | Michael P Johnson |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1366480592 PECOS PAC ID: 0143200378 Enrollment ID: I20040720001198 |
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