Provider Demographics
NPI:1083723324
Name:OHMAN, JOHN L (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:L
Last Name:OHMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 MAPLECREST DRIVE
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772
Mailing Address - Country:US
Mailing Address - Phone:508-481-2594
Mailing Address - Fax:508-624-6264
Practice Address - Street 1:750 WASHINGTON ST
Practice Address - Street 2:NEMC BOX 30
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02111-1526
Practice Address - Country:US
Practice Address - Phone:617-636-5000
Practice Address - Fax:617-636-4843
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2010-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA31138207K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207K00000XAllopathic & Osteopathic PhysiciansAllergy & Immunology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2015528Medicaid
MAC46279Medicare UPIN
MAB32075Medicare ID - Type Unspecified
MAHX4391Medicare PIN