Provider Demographics
NPI:1548356629
Name:JOHNSON, LAURA JOYCE (MD)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JOYCE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:J
Other - Last Name:RENDANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:196 NORTH ST
Mailing Address - Street 2:GENEVA GENERAL HOSPITAL EMERGENCY DEPARTMENT
Mailing Address - City:GENEVA
Mailing Address - State:NY
Mailing Address - Zip Code:14456-1651
Mailing Address - Country:US
Mailing Address - Phone:315-787-4500
Mailing Address - Fax:
Practice Address - Street 1:196 NORTH ST
Practice Address - Street 2:GENEVA GENERAL HOSPITAL EMERGENCY DEPARTMENT
Practice Address - City:GENEVA
Practice Address - State:NY
Practice Address - Zip Code:14456-1651
Practice Address - Country:US
Practice Address - Phone:315-787-4500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY237823207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02831670Medicaid
NYJ400067328Medicare PIN
NYJ400000708Medicare PIN
NY02831670Medicaid
NYJ400067416Medicare PIN