Provider Demographics
NPI:1972669687
Name:KATHERINE E. JOHNSON, M.D., INC.
Entity Type:Organization
Organization Name:KATHERINE E. JOHNSON, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-673-8689
Mailing Address - Street 1:60 WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:KENTON
Mailing Address - State:OH
Mailing Address - Zip Code:43326-2080
Mailing Address - Country:US
Mailing Address - Phone:419-673-8689
Mailing Address - Fax:
Practice Address - Street 1:60 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:KENTON
Practice Address - State:OH
Practice Address - Zip Code:43326-2080
Practice Address - Country:US
Practice Address - Phone:419-673-8689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2326754Medicaid
OH2326754Medicaid