Theodore L Johnson, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

0420006640 Issued in VT

Practice address

194 North Street
Bennington, VT 05201

Phone

(802) 442-2264

Fax

(802) 442-2337

NPI assigned

Nov 28, 2005

Last updated

Oct 3, 2011By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Brookside Pediatrics & Adolescent Medicine PLLC

  • Pediatrics Physician
  • Bennington, VT
  • NPI 1568578656
  Authorized official Same address or phone

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1133136000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1317600000000",
    "number": "1831172485",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "194 NORTH STREET",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "05201",
            "telephone_number": "802-442-2264",
            "fax_number": "802-442-2337"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "194 NORTH STREET",
            "city": "BENNINGTON",
            "state": "VT",
            "postal_code": "05201",
            "telephone_number": "802-442-2264",
            "fax_number": "802-442-2337"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSON",
        "first_name": "THEODORE",
        "middle_name": "L",
        "credential": "MD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2005-11-28",
        "last_updated": "2011-10-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "VT",
            "license": "0420006640",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0005309",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Thomas E Jager, MD
• Molly Ann Javarone
• Jodi Lawliss-Corrado Inc
• John J Orzehowski
• Lyndsey Johnson
• Katelyn Juliano
• K and L Associates
• Adam Patrick Kaftan
• Steven Louis Kane, D.D.S.
• Katherine J Baum PC

• Pediatrics Physician in Bennington, VT
• Providers in Bennington, VT by specialty
• Pediatrics Physician in Vermont

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.