Provider Demographics
NPI:1245212471
Name:JOHNSTON, DAVID L (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:158 DANBURY RD
Mailing Address - Street 2:STE 6
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-3227
Mailing Address - Country:US
Mailing Address - Phone:203-438-9915
Mailing Address - Fax:203-431-4410
Practice Address - Street 1:158 DANBURY RD
Practice Address - Street 2:STE 6
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-3227
Practice Address - Country:US
Practice Address - Phone:203-438-9915
Practice Address - Fax:203-431-4410
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-15
Last Update Date:2012-09-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT000523208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
010000751Medicare ID - Type Unspecified
H17325Medicare UPIN