Provider Demographics
NPI:1033300728
Name:JOHNSON, MARIA ELENA (MD)
Entity Type:Individual
Prefix:DR
First Name:MARIA
Middle Name:ELENA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:ELENA
Other - Last Name:SORIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:85 SEYMOUR ST
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-246-2571
Mailing Address - Fax:860-246-3691
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-246-2571
Practice Address - Fax:860-246-3691
Is Sole Proprietor?:No
Enumeration Date:2007-08-07
Last Update Date:2012-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT048571207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008040276Medicaid
CTD400071833Medicare PIN