Individual
THEODORE L JOHNSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
194 NORTH STREET, BENNINGTON, VT 05201
(802) 442-2264
(802) 442-2337
Mailing address
194 NORTH STREET, BENNINGTON, VT 05201
(802) 442-2264
(802) 442-2337
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0420006640
VT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0005309
—
VT
Enumeration date
11/28/2005
Last updated
10/03/2011
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