Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | 258657 | MA |
N | 207VF0040X | Female Pelvic Medicine and Reconstructive Surgeon | 258657 | MA |
Y | 207VG0400X | Gynecologist | 258657 | MA |
NPI | 1194005934 |
---|---|
Provider Name | Angel Marie Johnson |
First Address | Dedham, MA 02026-6022 |
Second Address | New York, MA 10028-7173 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 29/01/2020 |