Provider Demographics
NPI:1255309662
Name:JOHNSON, CAROL J (PA)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:J
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LEWIS BAY RD
Mailing Address - Street 2:PRIMARY CARE INTERNISTS
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601
Mailing Address - Country:US
Mailing Address - Phone:508-862-5560
Mailing Address - Fax:508-771-7321
Practice Address - Street 1:22 LEWIS BAY RD
Practice Address - Street 2:PRIMARY CARE INTERNISTS
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601
Practice Address - Country:US
Practice Address - Phone:508-862-5560
Practice Address - Fax:508-771-7321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA346363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q30382Medicare UPIN
AP2297Medicare ID - Type Unspecified