Basic Information
Provider Information
NPI: 1518916014
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSON
FirstName: PAULA
MiddleName: ADINA
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 111 CYPRESS ST
Address2: BRIGHAM AND WOMENS PHYSICIANS ORGANIZATION
City: BROOKLINE
State: MA
PostalCode: 02445
CountryCode: US
TelephoneNumber: 8573070896
FaxNumber:  
Practice Location
Address1: 75 FRANCIS ST PB-ADMIN-5
Address2: BWH DEPT OF MEDICINE WOMENS HEALTH DIVISION
City: BOSTON
State: MA
PostalCode: 02115
CountryCode: US
TelephoneNumber: 6177328985
FaxNumber: 6172645191
Other Information
ProviderEnumerationDate: 05/10/2006
LastUpdateDate: 08/07/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207RC0000X58897MAY Allopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease

No ID Information.


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