Provider Demographics
NPI:1346336237
Name:JOHNSON, FIELDING III (MD)
Entity Type:Individual
Prefix:DR
First Name:FIELDING
Middle Name:
Last Name:JOHNSON
Suffix:III
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 1:7 FALCON LN
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-2731
Mailing Address - Country:US
Mailing Address - Phone:860-633-6706
Mailing Address - Fax:
Practice Address - Street 1:893 MAIN ST STE 202
Practice Address - Street 2:
Practice Address - City:EAST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06108-2293
Practice Address - Country:US
Practice Address - Phone:860-528-4124
Practice Address - Fax:860-282-1213
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2021-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038695207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110007926Medicare ID - Type Unspecified
CTE09532Medicare UPIN