Individual
SANDRA DIANE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
208 MILL ROAD, FAIRHAVEN, MA 02719-5252
(508) 973-2432
(508) 973-2435
Mailing address
200 MILL RD, SUITE 180, FAIRHAVEN, MA 02719-5252
(508) 973-2000
(508) 973-2001
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
231054
MA
207Q00000X
Family Medicine Physician
MD11384
RI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7056488
—
RI
Enumeration date
12/05/2005
Last updated
04/22/2020
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