Provider Demographics
NPI:1275686214
Name:JOHNSON, KENNETH E (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:2 TRAP FALLS ROAD
Mailing Address - Street 2:SUITE 414
Mailing Address - City:EAST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06108-7301
Mailing Address - Country:US
Mailing Address - Phone:203-929-7353
Mailing Address - Fax:203-929-0756
Practice Address - Street 1:2 TRAP FALLS RD
Practice Address - Street 2:SUITE 414
Practice Address - City:SHELTON
Practice Address - State:CT
Practice Address - Zip Code:06484-4616
Practice Address - Country:US
Practice Address - Phone:203-929-7353
Practice Address - Fax:203-929-0756
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2016-07-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA242318207L00000X
VA0101248348207L00000X
NY261461207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology