Provider Demographics
NPI:1275515652
Name:JOHNSTON, MICHAEL G (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:G
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MICHAEL
Other - Middle Name:GWYNNE
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2790 GODWIN BLVD STE 305
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-8158
Mailing Address - Country:US
Mailing Address - Phone:757-934-4222
Mailing Address - Fax:757-934-4111
Practice Address - Street 1:620 JOHN PAUL JONES CIR
Practice Address - Street 2:NMCP - DEPT OF GENERAL SURGERY
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23708-2111
Practice Address - Country:US
Practice Address - Phone:757-953-2516
Practice Address - Fax:757-953-0845
Is Sole Proprietor?:No
Enumeration Date:2005-11-19
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101236832208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery