Johnson, Theodore L
Johnson, Theodore L is an sole proprietor health care provider with primary practice located at 194 North Street , Bennington VT 05201. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as his primary health care specialty. Johnson, Theodore L can be contacted via phone (802) 442-2264.Contact Information
Primary practice address
194 North Street
Bennington VT 05201
Phone: (802) 442-2264
Fax: (802) 442-2337
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pediatrics | 208000000X | 0420006640 | Vermont |
Profile Details
| NPI number | 1831172485 |
|---|---|
| LBN Legal business name | Johnson, Theodore L |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 28th, 2005 |
| Last updated | Oct 3rd, 2011 - about 14 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831172485 | NPPES |
| Vermont | MEDICAID | 0005309 |
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