Individual
MICHAEL L. JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
147 MILK ST, BOSTON, MA 02109-4806
(617) 654-7300
Mailing address
147 MILK ST, PROVIDER ENROLLMENT 9TH FLOOR, BOSTON, MA 02109-4806
(617) 559-8051
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
49568
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0017366
NEIGHBORHOOD HEALTH PLAN
MA
01
—
049568
TUFTS HEALTH PLAN
MA
01
—
B36042
BLUE CROSS
MA
Enumeration date
06/05/2006
Last updated
04/08/2009
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