Individual
KEVIN M JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
55 LOCK STREET, NEW HAVEN, CT 06520-8237
(203) 432-0076
(203) 432-7289
Mailing address
PO BOX 208237, 55 LOCK STREET, NEW HAVEN, CT 06520-8237
(203) 432-0076
(203) 432-7289
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
032236
CT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001322362
—
CT
Enumeration date
11/08/2005
Last updated
12/29/2010
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