Provider Demographics
NPI:1518026830
Name:JOHNSON, VIRGINIA B (MD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:B
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 351 SILVER STREET
Mailing Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Mailing Address - City:MIDDLETOWN
Mailing Address - State:CT
Mailing Address - Zip Code:06457
Mailing Address - Country:US
Mailing Address - Phone:860-262-5867
Mailing Address - Fax:860-262-5850
Practice Address - Street 1:SILVER STREET
Practice Address - Street 2:CONNECTICUT VALLEY HOSPITAL
Practice Address - City:MIDDLETOWN
Practice Address - State:CT
Practice Address - Zip Code:06457
Practice Address - Country:US
Practice Address - Phone:860-262-5867
Practice Address - Fax:860-262-5850
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT0166962084P0800X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Not Answered2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
D02864Medicare UPIN