Provider Demographics
NPI:1558348714
Name:JOHNSTON, MARTHA ANNE (MD)
Entity Type:Individual
Prefix:
First Name:MARTHA
Middle Name:ANNE
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 1:415 BYERS RD
Mailing Address - Street 2:STE 300
Mailing Address - City:MIAMISBURG
Mailing Address - State:OH
Mailing Address - Zip Code:45342-3684
Mailing Address - Country:US
Mailing Address - Phone:937-866-2494
Mailing Address - Fax:937-866-8494
Practice Address - Street 1:415 BYERS RD
Practice Address - Street 2:STE 300
Practice Address - City:MIAMISBURG
Practice Address - State:OH
Practice Address - Zip Code:45342-3684
Practice Address - Country:US
Practice Address - Phone:937-866-2494
Practice Address - Fax:937-866-8494
Is Sole Proprietor?:No
Enumeration Date:2005-12-29
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.050078207P00000X
OH35050078J207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHJO0658682OtherMEDICARE PTAN
OH0658681OtherMEDICARE PTAN
OH0658686OtherMEDICARE PTAN
OH153891Medicaid
E51853Medicare UPIN