Provider Demographics
NPI:1821194267
Name:JOHNSON, DAVID MARTIN (DO)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:MARTIN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:36 OLD SOUTH FREEPORT ROAD
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:ME
Mailing Address - Zip Code:04032-6146
Mailing Address - Country:US
Mailing Address - Phone:207-865-0341
Mailing Address - Fax:207-865-0817
Practice Address - Street 1:36 OLD SOUTH FREEPORT ROAD
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:ME
Practice Address - Zip Code:04032-6146
Practice Address - Country:US
Practice Address - Phone:207-865-0341
Practice Address - Fax:207-865-0817
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME795207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103890000Medicaid
MEJ069205Medicare PIN
D94296Medicare UPIN