Provider Demographics
NPI:1619175460
Name:JOHNSTON, MARK R (MD)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:R
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARK
Other - Middle Name:R
Other - Last Name:JOHNSTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:WESTCHESTER COUNTY DEPARTMENT OF HEALTH
Mailing Address - Street 2:145 HUGUENOT STREET
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-5234
Mailing Address - Country:US
Mailing Address - Phone:914-813-5237
Mailing Address - Fax:
Practice Address - Street 1:WESTCHESTER COUNTY DEPARTMENT OF HEALTH
Practice Address - Street 2:145 HUGUENOT STREET
Practice Address - City:NEW ROCHELLE
Practice Address - State:NY
Practice Address - Zip Code:10801-5234
Practice Address - Country:US
Practice Address - Phone:914-813-5237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-03
Last Update Date:2017-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY149047207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine