Individual
MATTHEW L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
251 WOODFORD ST, PORTLAND, ME 04103-5617
(207) 773-2828
(207) 761-8150
Mailing address
251 WOODFORD ST, PORTLAND, ME 04103-5617
(207) 773-2828
(207) 761-8150
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
ME012756
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
040224
ANTHEM
ME
01
—
100504700
OWCP
ME
01
—
108913
MARTIN'S POINT
ME
05
—
228090000
—
ME
Enumeration date
01/01/2007
Last updated
07/23/2018
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