Provider Demographics
NPI:1831256379
Name:JOHNSON BHEMBE, XENIA (MD)
Entity type:Individual
Prefix:
First Name:XENIA
Middle Name:
Last Name:JOHNSON BHEMBE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:XENIA
Other - Middle Name:
Other - Last Name:JOHNSON BHEMBE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 870261
Mailing Address - Street 2:
Mailing Address - City:MILTON VILLAGE
Mailing Address - State:MA
Mailing Address - Zip Code:02187-0261
Mailing Address - Country:US
Mailing Address - Phone:617-690-2011
Mailing Address - Fax:888-312-9236
Practice Address - Street 1:1 BROOKLINE PL STE 502
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-7277
Practice Address - Country:US
Practice Address - Phone:617-690-2011
Practice Address - Fax:888-312-9236
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1582212084P0804X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAH29427Medicare UPIN