Provider Demographics
NPI:1770578742
Name:JOHNSTON, JAMES (MD)
Entity type:Individual
Prefix:
First Name:JAMES
Middle Name:
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 1:31 STILES RD
Mailing Address - Street 2:STE 1200
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-2897
Mailing Address - Country:US
Mailing Address - Phone:603-893-4352
Mailing Address - Fax:603-894-4522
Practice Address - Street 1:31 STILES RD
Practice Address - Street 2:STE 1200
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-2897
Practice Address - Country:US
Practice Address - Phone:603-893-4352
Practice Address - Fax:603-894-4522
Is Sole Proprietor?:No
Enumeration Date:2005-09-15
Last Update Date:2014-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH69342085R0202X
MA526772085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA6181635Medicaid
MAR01100Medicare PIN
NHRE0863Medicare PIN
MAFX6841Medicare PIN
MA6181635Medicaid