Individual
MARY JOHNSTON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
391 MYRTLE AVENUE, SUITE 4A, ALBANY, NY 12208
(518) 207-2273
(518) 207-2293
Mailing address
711 TROY SCHENECTADY RD, SUITE 203, LATHAM, NY 12110-2442
(518) 782-3700
(518) 782-3799
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
167722
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
01054966
—
NY
Enumeration date
10/25/2006
Last updated
12/11/2015
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