Provider Demographics
NPI:1073504445
Name:JOHNSTON, THOMAS C (MD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:C
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:51 MILL ST
Mailing Address - Street 2:BUILDING E - 17
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1641
Mailing Address - Country:US
Mailing Address - Phone:781-826-2131
Mailing Address - Fax:781-826-4513
Practice Address - Street 1:51 MILL ST
Practice Address - Street 2:BUILDING E - 17
Practice Address - City:HANOVER
Practice Address - State:MA
Practice Address - Zip Code:02339-1641
Practice Address - Country:US
Practice Address - Phone:781-826-2131
Practice Address - Fax:781-826-4513
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2012-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA50326208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ02075OtherBCBS
1200530OtherUNITED
MA3093182Medicaid
MA20961OtherHPHC
050326OtherTUFTS
3552816OtherCIGNA
MAJ02075OtherBCBS
MA3093182Medicaid