Provider Demographics
NPI:1053500447
Name:JOHNSON, CLIVE LLOYD (DO)
Entity Type:Individual
Prefix:
First Name:CLIVE
Middle Name:LLOYD
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE HOSPITAL PLAZA
Mailing Address - Street 2:
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06904
Mailing Address - Country:US
Mailing Address - Phone:203-276-7298
Mailing Address - Fax:203-355-4842
Practice Address - Street 1:ONE HOSPITAL PLAZA
Practice Address - Street 2:
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06904
Practice Address - Country:US
Practice Address - Phone:203-276-7298
Practice Address - Fax:203-355-4842
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2016-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT047287207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine