Provider Demographics
NPI:1801816509
Name:JOHNSON, ROBERT M (MD)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:JOHNSON
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 1:601 ELMWOOD AVE
Mailing Address - Street 2:BOX 604
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14642-0001
Mailing Address - Country:US
Mailing Address - Phone:585-275-5982
Mailing Address - Fax:585-756-0169
Practice Address - Street 1:601 ELMWOOD AVE
Practice Address - Street 2:BOX 604
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14642-0001
Practice Address - Country:US
Practice Address - Phone:585-275-5982
Practice Address - Fax:585-756-0169
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY190032207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP010190032OtherBLUE CHOICE
NY2222OtherBLUE SHIELD GROUP ID
NY5361500OtherAETNA PROVIDER ID
NY00025578401OtherUNIVERA PROVIDER ID
NY5399010OtherGHI PROVIDER ID
NY01388063Medicaid
NY190032-3OtherWORKER'S COMP
NY000915578001OtherBS WNY/HEALTHNOW ID
NY050063375OtherRAILROAD MEDICARE
NYG0189393590OtherBLUE CHOICE GROUP ID
NYMDC631OtherPREFERRED CARE
NY000915578001OtherBS WNY/HEALTHNOW ID
NY5361500OtherAETNA PROVIDER ID