Basic Information
Provider Information
NPI: 1871706754
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: JOHNSTON
FirstName: CHRISTINE
MiddleName: JANICE
NamePrefix: DR.
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 690 CANTON ST
Address2: SUITE 325
City: WESTWOOD
State: MA
PostalCode: 020902321
CountryCode: US
TelephoneNumber: 7814077713
FaxNumber: 7814070998
Practice Location
Address1: 164 SUMMIT AVE
Address2:  
City: PROVIDENCE
State: RI
PostalCode: 029062853
CountryCode: US
TelephoneNumber: 4017934574
FaxNumber:  
Other Information
ProviderEnumerationDate: 05/08/2007
LastUpdateDate: 02/15/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000XMD12695RIY Allopathic & Osteopathic PhysiciansAnesthesiology 

No ID Information.


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