AMANDA C. JOHNSON


Address: 55 Lake Ave N, Worcester, MA 01655-0002
Phone: 7744422164

AMANDA C. JOHNSON (NPI# 1285995589) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).

Provider Overview

Nation Provider ID (NPI) 1285995589
Entity Type Individual
Full Name AMANDA C. JOHNSON
Credential M.D.
Practice Address 55 Lake Ave N
Worcester
MA 01655-0002
Mailing Address Po Box 415348
Boston
MA 02241-5348
Practice Telephone 7744422164
Practice Fax Number 7744432062
Mailing Telephone 8002258885
Mailing Fax Number 5083341977
Enumeration Date 2012-06-04
Last Update Date 2019-06-13
Gender Code F
Is Sole Proprietor N

Taxonomy

Primary Taxonomy Code Classification License Number License State Taxonomy Group
Y 2080P0203X Pediatrics
Specialization: Pediatric Critical Care Medicine
262592 MA Allopathic & Osteopathic Physicians

Other Provider Identifier

State Issuer Identifier Type Code
MA 110099386A 05

Other Providers AMANDA JOHNSON

NPI Name Taxonomy Address Enumeration
1366040826 Amanda Johnson Technician 1401 S Seward Meridian Pkwy # Ab, Wasilla, AK 99654-8312 2020-10-15
1184221178 Amanda Elisa Johnson Registered Nurse 36 Chadwick Mnr, Fairport, NY 14450-8820 2020-10-03
1487263422 Amanda Johnson Nurse Practitioner 1112 N Main Ave, Erwin, TN 37650-1508 2020-07-27
1922579234 Amanda Johnson Social Worker 701 Zellwood Cir, Talladega, AL 35160 2018-12-12
1275022279 Amanda Johnson Chiropractor 14555 E Arapahoe Rd Unit B, Aurora, CO 80016-1584 2018-05-04
1215438031 Amanda D Johnson Licensed Practical Nurse 501 Fletcher Ave Apt 12, Lincoln, NE 68521-1364 2018-02-27
1508374174 Amanda L Johnson Nurse Practitioner 108 Brenray Dr, Harriman, TN 37748-5148 2018-01-17
1063935807 Amanda Nicole Johnson Home Health Aide 5831 Ravenna Ave, Louisville, OH 44641-9216 2017-07-24
1174058283 Amanda Johnson Counselor 8370 Us Highway 82 E, Sherman, TX 75090-2404 2017-04-26
1023556255 Amanda Johnson Community Based Residential Treatment Facility, Mental Illness 1442 Valota Rd, Redwood City, CA 94061-2620 2017-02-08

Office Location

Street Address 55 LAKE AVE N
City WORCESTER
State MA
Zip Code 01655-0002

Providers in the same location

NPI Name Taxonomy Address Enumeration
1477556587 James E Liebmann Internal Medicine 55 Lake Ave N, Hematology/oncology, Worcester, MA 01655-0002 2005-05-23
1518568732 Justin Bullard Psychologist 55 Lake Ave N, Worcester, MA 01655-0002 2020-11-04
1346849825 Meghan Moore Nurse Practitioner 55 Lake Ave N, Worcester, MA 01655-0002 2020-10-26
1174122899 Jessica Goncalves Ferreira Nurse Practitioner 55 Lake Ave N, Worcester, MA 01655-0002 2020-10-23
1235746686 Desiree Mytych Student in an Organized Health Care Education/Training Program 55 Lake Ave N, Worcester, MA 01655-0002 2020-09-29
1659986248 Rebecca Lynn Harris Student in an Organized Health Care Education/Training Program 55 Lake Ave N, Worcester, MA 01655-0002 2020-09-10
1639781487 Gabriella Kathleen Holland Student in an Organized Health Care Education/Training Program 55 Lake Ave N, Worcester, MA 01655-0002 2020-08-21
1730791898 Kerry Anne Benedict Speech-Language Pathologist 55 Lake Ave N, Worcester, MA 01655-0002 2020-08-20
1902418999 Natasha R. Turner Genetic Counselor, MS 55 Lake Ave N, Worcester, MA 01655-0002 2020-08-20
1144830712 Abbey Corsini Nurse Practitioner 55 Lake Ave N, Worcester, MA 01655-0002 2020-08-07
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Providers in the same zip code

NPI Name Taxonomy Address Enumeration
1205489713 Darryl Sweeper Jr. Student in an Organized Health Care Education/Training Program 55 Lake Avenue North, Psychiatry, Umass Memorial Medical Center, Worcester, MA 01655 2019-07-23
1225690530 Ryan Zenevitch Student in an Organized Health Care Education/Training Program 55 Lake Avenue North, Family Medicine, Umass Memorial Medical Center, Worcester, MA 01655 2019-07-08
1932688454 Victoria Sayeg Student in an Organized Health Care Education/Training Program 55 Lake Avenue North, Pediatrics, Worcester, MA 01655 2018-08-07
1114425675 Judith Dio Wentzell Social Worker Umassmemorial Medical Center, 55 Lake Ave North, Dept of Care Coordination, Worcester, MA 01655 2018-01-30
1861927386 Muhammad Waqas Khan Student in an Organized Health Care Education/Training Program University of Massachusetts 55 North Lake Ave, Neurology, Worcester, MA 01655 2017-04-21
1861806192 Qaiser Shamshir Khan Psychiatry & Neurology 55 Lake Ave N # S7-831, Worcester, MA 01655 2014-06-14
1073858981 Heidi Glover Nurse Practitioner 55 Lake Ave North Dept. of Pedi-adolescent, Ummc University Campus, Worcester, MA 01655 2012-12-04
1972867992 Anna Bjornsdottir Psychiatry & Neurology 55 Lake Av N, Worcester, MA 01655 2012-06-25
1245567676 Steven Edward Mckinley Nurse Practitioner 55 Lake Ave. North, Umass Memorial Medical Center University Campus, Worcester, MA 01655 2009-11-05
1851582951 Robin I Davidson Neurological Surgery 55 Lake Ave, North, Ummhc-univ Campus, Worcester, MA 01655 2007-08-05
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Taxonomy Information

Taxonomy Code 2080P0203X
Grouping Allopathic & Osteopathic Physicians
Classification Pediatrics
Specialization Pediatric Critical Care Medicine

Taxonomy Definition

A pediatrician expert in advanced life support for children from the term or near-term neonate to the adolescent. This competence extends to the critical care management of life-threatening organ system failure from any cause in both medical and surgical patients and to the support of vital physiological functions. This specialist may have administrative responsibilities for intensive care units and also facilitates patient care among other specialists.
Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. ACGME Accredited Residency Program Requirements: 2 years of training with 3 years Pediatrics plus 1 year Pediatric Critical Care for certification for a total of 6 years. ABMS Approved Subspecialty Certificate (Pediatrics)

Providers in the same taxonomy and state

NPI Name Taxonomy Address Enumeration
1326699935 Colin Meyer-macaulay Pediatrics 300 Longwood Ave, Boston, MA 02115-5724 2019-09-25
1902303480 Haley Devries Pediatrics 300 Longwood Ave, Boston, MA 02115-5724 2018-04-10
1194272013 Cheuk Chung Au Pediatrics 300 Longwood Ave, Bader 634, Boston, MA 02115-5724 2016-09-08
1669896775 Pallav Bhattarai Pediatrics 759 Chestnut Street, Springfield, MA 01107-1619 2014-02-10
1215378435 Peta-maree Ann Alexander Pediatrics Boston Children's Hospital, 300 Longwood Avenue, Cardiology Department, Boston, MA 02115 2013-07-16
1013352277 Sarah Elyse Hendrickson Pediatrics 300 Longwood Ave, Boston, MA 02115-5724 2013-05-01
1841556305 Jane Whitney Pediatrics 300 Longwood Ave, Boston, MA 02115-5724 2012-04-09
1891061768 Jennifer Ann Blumenthal Pediatrics 300 Longwood Ave, Boston, MA 02115-5724 2012-03-26
1679848782 Daniel Hames Pediatrics 300 Longwood Ave, Boston, MA 02115-5724 2012-03-22
1912297045 Ben D Albert Pediatrics 300 Longwood Ave, Bader 634 - Critical Care Medicine, Boston, MA 02115-5724 2011-04-11
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Competitor

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City WORCESTER
Zip Code 01655

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Dataset Information

Data Provider Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES)
Jurisdiction Medicare & Medicaid

This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.

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