Provider Demographics
NPI:1609026129
Name:JOHNSON, LINDSAY JESSICA (DPM)
Entity Type:Individual
Prefix:DR
First Name:LINDSAY
Middle Name:JESSICA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 INDEPENDENCE DR
Mailing Address - Street 2:PODIATRY DEPT
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-541-6611
Mailing Address - Fax:617-541-7550
Practice Address - Street 1:291 INDEPENDENCE DR
Practice Address - Street 2:PODIATRY DEPT.
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6611
Practice Address - Fax:617-541-7550
Is Sole Proprietor?:No
Enumeration Date:2008-09-19
Last Update Date:2011-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2368213ES0103X
MA1211390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110087324AMedicaid
MA001949801Medicare PIN