Provider Demographics
NPI:1568449320
Name:JOHNSTON, WILLIAM G JR (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:JOHNSTON
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:WILLIAM
Other - Middle Name:G
Other - Last Name:JOHNSTON
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:110 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-3127
Mailing Address - Country:US
Mailing Address - Phone:508-771-9550
Mailing Address - Fax:508-790-9304
Practice Address - Street 1:110 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3127
Practice Address - Country:US
Practice Address - Phone:508-771-9550
Practice Address - Fax:508-790-9304
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38955208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2045133Medicaid
MA340000696OtherRAILROAD MEDICARE
MA000000029926OtherBMC HEALTHNET
MA2077564001OtherCIGNA
MAL15100OtherBLUE CROSS BLUE SHIELD
MA27036OtherHARVARD PILGRIM HEALTH
MA757982OtherTUFTS HEALTH PLAN
MAGX3515Medicare PIN
MA27036OtherHARVARD PILGRIM HEALTH