Individual
JARRED JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
101 DATES DR, ITHACA, NY 14850-1342
(607) 277-2365
(607) 277-0104
Mailing address
1301 TRUMANSBURG RD, SUITE P, ITHACA, NY 14850-1397
(607) 277-2365
(607) 277-0104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
274233
NY
208M00000X
Hospitalist Physician
Primary
274233
NY
Other
Enumeration date
03/28/2011
Last updated
01/09/2018
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