Provider Demographics
NPI:1952455370
Name:WRIGHT, JOHNNY C (MD, DPM)
Entity Type:Individual
Prefix:DR
First Name:JOHNNY
Middle Name:C
Last Name:WRIGHT
Suffix:
Gender:M
Credentials:MD, DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 BROAD ST
Mailing Address - Street 2:STE 100
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3030
Mailing Address - Country:US
Mailing Address - Phone:413-505-4888
Mailing Address - Fax:
Practice Address - Street 1:340 BROAD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:WINDSOR
Practice Address - State:CT
Practice Address - Zip Code:06095-3030
Practice Address - Country:US
Practice Address - Phone:860-580-7170
Practice Address - Fax:860-580-7177
Is Sole Proprietor?:No
Enumeration Date:2007-01-23
Last Update Date:2016-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT049981207Q00000X
MS80178213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT008045010Medicaid
1679974521OtherNPI
CT008056720Medicaid
D300052726Medicare PIN
D100231942Medicare PIN