Provider Demographics
NPI:1760543318
Name:JOHNSTON, DANIEL EDWIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:EDWIN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 BEESTON HILL MEDICAL CTR
Mailing Address - Street 2:2
Mailing Address - City:CHRISTIANSTED
Mailing Address - State:VI
Mailing Address - Zip Code:00820-4885
Mailing Address - Country:US
Mailing Address - Phone:340-773-3703
Mailing Address - Fax:340-773-3703
Practice Address - Street 1:4000 BEESTON HILL
Practice Address - Street 2:#2
Practice Address - City:CHRISTIANSTED
Practice Address - State:VI
Practice Address - Zip Code:00820
Practice Address - Country:US
Practice Address - Phone:340-773-3703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2011-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VI611207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
089077OtherBCBS
850004YOtherHUMANE NUMBER
850004YOtherHUMANE NUMBER