Provider Demographics
NPI:1770897068
Name:JOHNSTON, PETER SHIVERS (MD)
Entity type:Individual
Prefix:DR
First Name:PETER
Middle Name:SHIVERS
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 1:412 MORRIS AVE
Mailing Address - Street 2:APT 18
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901-1577
Mailing Address - Country:US
Mailing Address - Phone:908-598-9546
Mailing Address - Fax:908-231-5625
Practice Address - Street 1:10 KODIAK ROAD
Practice Address - Street 2:P.O. BOX 67
Practice Address - City:BARRYVILLE
Practice Address - State:NY
Practice Address - Zip Code:12719
Practice Address - Country:US
Practice Address - Phone:845-557-0456
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-29
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT032117207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism