Provider Demographics
NPI:1437107059
Name:JOHNSTON, MARIAN ELAINE (MD)
Entity Type:Individual
Prefix:
First Name:MARIAN
Middle Name:ELAINE
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 N 18TH ST
Mailing Address - Street 2:SUITE # B
Mailing Address - City:MOUNT VERNON
Mailing Address - State:WA
Mailing Address - Zip Code:98273-3902
Mailing Address - Country:US
Mailing Address - Phone:360-336-0123
Mailing Address - Fax:
Practice Address - Street 1:125 N 18TH ST
Practice Address - Street 2:SUITE # B
Practice Address - City:MOUNT VERNON
Practice Address - State:WA
Practice Address - Zip Code:98273-3902
Practice Address - Country:US
Practice Address - Phone:360-336-0123
Practice Address - Fax:360-336-0126
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00035789207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8247710Medicaid
WA8247710Medicaid
WAGAB38120Medicare ID - Type Unspecified