Provider Demographics
NPI:1609854918
Name:JOHNSON, JANET LEE (MD)
Entity type:Individual
Prefix:
First Name:JANET
Middle Name:LEE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:REGIONAL MEDICAL PRACTICE, PC
Mailing Address - Street 2:134 HOMER AVENUE
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:607-758-8019
Mailing Address - Fax:607-758-8210
Practice Address - Street 1:REGIONAL MEDICAL PRACTICE, PC
Practice Address - Street 2:4077 WEST ROAD
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:607-753-9977
Practice Address - Fax:607-218-6276
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2018-06-11
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY186216207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYE93940Medicare UPIN
NYRA2847Medicare PIN
NYP00385022Medicare PIN