Provider Demographics
NPI:1265680375
Name:JOHNSON, MATTHEW T (MD)
Entity Type:Individual
Prefix:
First Name:MATTHEW
Middle Name:T
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 1:17 RIVERSIDE ST STE 201
Mailing Address - Street 2:LAHEY UROLOGY AT NASHUA
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03062-1383
Mailing Address - Country:US
Mailing Address - Phone:603-594-0800
Mailing Address - Fax:
Practice Address - Street 1:17 RIVERSIDE ST STE 201
Practice Address - Street 2:LAHEY UROLOGY AT NASHUA
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03062-1383
Practice Address - Country:US
Practice Address - Phone:603-594-0800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125055475208600000X
NH16113208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
No208600000XAllopathic & Osteopathic PhysiciansSurgery