Provider Demographics
NPI:1467445668
Name:JOHNSON, KRISTINA HOPE (MD)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:HOPE
Last Name:JOHNSON
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 1:85 SEYMOUR ST
Mailing Address - Street 2:STE 425
Mailing Address - City:HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06106-5501
Mailing Address - Country:US
Mailing Address - Phone:860-548-7336
Mailing Address - Fax:860-524-2651
Practice Address - Street 1:85 SEYMOUR ST
Practice Address - Street 2:STE 425
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06106-5501
Practice Address - Country:US
Practice Address - Phone:860-548-7336
Practice Address - Fax:860-524-2651
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT038758208600000X, 208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT0V6664OtherHEALTH NET
CT26208OtherHEALTH NEW ENGLAND
MA0121525Medicaid
CT038758OtherCONNECTICARE
CT010038758CT01OtherANTHEM BCBS
CT2323679OtherAETNA
CT3147288 001OtherCIGNA
CTP2468775OtherOXFORD
CTP2468775OtherOXFORD