Individual
MICHELLE M JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1656 CHAMPLIN AVE, UTICA, NY 13502
(315) 624-6241
(315) 624-6395
Mailing address
2209 GENESEE STREET, BUSINESS OFFICE ROOM 310, UTICA, NY 13501-5930
(315) 801-3282
(315) 801-8391
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
219360
NY
208VP0000X
Pain Medicine Physician
219360
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02192381
—
NY
Enumeration date
10/02/2005
Last updated
12/20/2018
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