Individual
MR. MARK HALEY JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDC
Contact information
Practice address
NLON MEDICAL DEPARTMENT BLDG 76, NAVAL SUBMARINE BASE, GROTON, CT 06340
(860) 694-2795
(860) 694-4326
Mailing address
197 CHARTER OAK DR, GROTON, CT 06340
(860) 865-0297
Taxonomy
Speciality
Code
Description
License number
State
1710I1002X
Independent Duty Corpsman
Primary
—
—
Other
Enumeration date
05/04/2007
Last updated
05/06/2011
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