Provider Demographics
NPI:1144237215
Name:JOHNSON, CARL E (MD)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:E
Last Name:JOHNSON
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:PO BOX 61
Mailing Address - Street 2:
Mailing Address - City:BOXFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01921-0061
Mailing Address - Country:US
Mailing Address - Phone:978-857-5722
Mailing Address - Fax:978-887-4539
Practice Address - Street 1:123 HIGH ST
Practice Address - Street 2:
Practice Address - City:TOPSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01983-1921
Practice Address - Country:US
Practice Address - Phone:978-921-1392
Practice Address - Fax:978-887-1971
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2023-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA46917207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0138576Medicaid
MA0138576Medicaid
E16129Medicare ID - Type Unspecified