Individual
ELLEN D JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
23 INGALLS VILLAGE WAY, BOXFORD, MA 01921-2248
(208) 416-2932
Mailing address
22100 BOTHELL EVERETT HWY, BOTHELL, WA 98021-8431
(208) 416-2932
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
0101276011
VA
2085R0202X
Diagnostic Radiology Physician
11090
NH
2085R0202X
Diagnostic Radiology Physician
Primary
247042
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01Y003105NH02
ANTHEM
NH
01
—
1204510
CIGNA
—
05
—
2081211
—
MA
05
—
286860099
—
ME
05
—
30201338
—
NH
01
—
7768225
AETNA
—
01
—
P00183990
RAILROAD MEDICARE
—
Enumeration date
07/18/2006
Last updated
12/05/2023
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