Individual
LENWORTH N JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1 HOPPIN ST, CORO WEST/STE 202, PROVIDENCE, RI 02903-4141
(401) 444-6551
Mailing address
1 HOPPIN ST, CORO WEST/STE 202, PROVIDENCE, RI 02903-4141
(401) 444-6551
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
MD14426
RI
207W00000X
Ophthalmology Physician
R7N60
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
131956
HEALTHLINK
MO
05
—
202887907
—
MO
01
—
2086330901
KANSAS MEDICAID
KS
01
—
804021
UNITED HEALTHCARE
MO
01
—
9312
BLUE SHIELD/BLUE CHOICE
MO
Enumeration date
05/05/2006
Last updated
10/22/2013
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