| Doctor Name: | MR. RANDY M JOHNSON |
| NPI Number: | 1073787677 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PA-C |
| License Number: | 002078 |
| Business Practice Address: | 2200 Whitney Avenue Suite 360 Hamden, CT - 065183694 |
| Business Phone Number: | 2032814463 |
| Business Fax Number: | 2032872930 |
| Mailing Address: | 2200 Whitney Avenue, Suite 360 HAMDEN |
| State: | CT |
| Postal Code: | 065183694 |
| Phone Number: | 2032814463 |
| Fax Number: | 2032872930 |
| NPI Enumeration Date: | 04/15/2008 |
| NPI Last Update Date: | 10/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 002078 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CT |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |