Provider Demographics
NPI:1134197734
Name:JOHNSON, KRISTEN CALCAGNI (MD)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:CALCAGNI
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KRISTEN
Other - Middle Name:WELLS
Other - Last Name:CALCAGNI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:7 HOLLAND WAY FL 1
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833-2997
Mailing Address - Country:US
Mailing Address - Phone:603-658-1823
Mailing Address - Fax:603-658-1824
Practice Address - Street 1:118 PORTSMOUTH AVE BLDG D
Practice Address - Street 2:
Practice Address - City:STRATHAM
Practice Address - State:NH
Practice Address - Zip Code:03885-2487
Practice Address - Country:US
Practice Address - Phone:603-658-1823
Practice Address - Fax:603-658-1824
Is Sole Proprietor?:No
Enumeration Date:2006-03-09
Last Update Date:2023-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH14058208000000X
VT042-0010845208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3075942Medicaid
VT1010907Medicaid
NH30207944Medicaid