Individual
MARK D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD PHD
Contact information
Practice address
55 LAKE AVE N, WORCESTER, MA 01655-0002
(508) 856-2963
Mailing address
PO BOX 415348, BOSTON, MA 02241-5348
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
217384
MA
Other
Enumeration date
06/02/2006
Last updated
10/26/2020
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