Provider Demographics
NPI:1912078767
Name:JOHNSON, CYNTHIA E (MD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:291 INDEPENDENCE DR FL 9
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-3628
Mailing Address - Country:US
Mailing Address - Phone:617-541-6450
Mailing Address - Fax:617-541-6645
Practice Address - Street 1:291 INDEPENDENCE DR FL 9
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-3628
Practice Address - Country:US
Practice Address - Phone:617-541-6450
Practice Address - Fax:617-541-6645
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA58139207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ08520OtherBLUE CROSS
MA7356354-002OtherCIGNA
MA3188558Medicaid
MAG268OtherHARVARD PILGRIM
MA058139OtherTUFTS HEALTH PLAN
MA0014790OtherNEIGHBORHOOD HEALTH PLAN
MAG268OtherHARVARD PILGRIM
MADX7866Medicare PIN