Johnson, Amanda C.

Johnson, Amanda C. is an individual health care provider with primary practice located at 55 Lake Ave N , Worcester MA 01655-0002. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine, which is considered as her primary health care specialty. Johnson, Amanda C. can be contacted via phone (774) 442-2164.

Contact Information

Primary practice address
55 Lake Ave N Worcester MA 01655-0002
Phone: (774) 442-2164
Fax: (774) 443-2062
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatric Critical Care Medicine 2080P0203X 262592 Massachusetts

Profile Details

NPI number 1285995589
LBN Legal business name Johnson, Amanda C.
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 4th, 2012
Last updated Nov 10th, 2020 - about 6 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1285995589 NPPES
Massachusetts MEDICAID 110099386A

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