Provider Demographics
NPI:1831162239
Name:JOHNSTON, CYNTHIA L (MD)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:JOHNSTON
Suffix:
Gender:F
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 500369
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:FL
Mailing Address - Zip Code:33050-0369
Mailing Address - Country:US
Mailing Address - Phone:305-304-0448
Mailing Address - Fax:
Practice Address - Street 1:3301 OVERSEAS HWY
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:FL
Practice Address - Zip Code:33050-2329
Practice Address - Country:US
Practice Address - Phone:305-743-5533
Practice Address - Fax:305-289-0630
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-08
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME94206207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL31076OtherBCBS
FL31076AMedicare PIN
E10011Medicare UPIN