Individual
DR. KEITH A JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
33 FRUIT ST, MASS GENERAL PHYSICAN ORGANIZATION, BOSTON, MA 02114-2621
(617) 724-7066
(617) 726-5123
Mailing address
PO BOX 9142, MASS GENERAL PHYSICAN ORGANIZATION, CHARLESTOWN, MA 02129-9142
(617) 724-7066
(617) 726-5123
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
50853
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6187668
—
MA
01
—
705161
TUFTS HEALTH PLAN
MA
01
—
J04057
BCBS MA
MA
Enumeration date
02/08/2006
Last updated
10/21/2014
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