Provider Demographics
NPI:1689796682
Name:JOHNSTON, SUZANNE CAROL (MD)
Entity Type:Individual
Prefix:DR
First Name:SUZANNE
Middle Name:CAROL
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 1:9 HOPE AVENUE
Mailing Address - Street 2:CHILDREN'S HOSPITAL AT WALTHAM / DEPT. OPHTHALMOLOGY
Mailing Address - City:WALTHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02453
Mailing Address - Country:US
Mailing Address - Phone:617-955-6401
Mailing Address - Fax:
Practice Address - Street 1:9 HOPE AVENUE
Practice Address - Street 2:CHILDREN'S HOSPITAL AT WALTHAM / DEPT. OPHTHALMOLOGY
Practice Address - City:WALTHAM
Practice Address - State:MA
Practice Address - Zip Code:02453
Practice Address - Country:US
Practice Address - Phone:617-355-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0116015550207W00000X
NC2007-00463207W00000X
MA237031207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology