Provider Demographics
NPI:1013984947
Name:JOHNSON, BRIAN (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:
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:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01061-1177
Mailing Address - Country:US
Mailing Address - Phone:413-586-8443
Mailing Address - Fax:413-582-8443
Practice Address - Street 1:30 LOCUST ST
Practice Address - Street 2:
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060-2052
Practice Address - Country:US
Practice Address - Phone:413-582-2105
Practice Address - Fax:413-582-2059
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-28
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA153887207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA04-3364403OtherPRIVATE HEALTHCARE SYSTEM
MA321917OtherCONNECTICARE
MA04-3364403OtherCONSOLIDATED
MA273698OtherHARVARD PILGRIM
MA812357OtherAETNA
MA04-3364403OtherNORTH AMERICAN PREFERRED
MA000000020117OtherBMC
MA04-3364403OtherUNICARE/GIC
MA20463OtherHEALTH NEW ENGLAND
MA615492OtherTUFTS
MA04-3364403OtherNORTHEAST HEALTH DIRECT
MA94881180001OtherCIGNA
MA04-3364403OtherNORTHEAST HEALTHCARE ALLI
MA3166856Medicaid
MA04-3364403OtherGREAT-WEST
MA04-3364403OtherPLAN VISTA
MA615492OtherTUFTS
G45683Medicare UPIN