Provider Demographics
NPI:1588455653
Name:JOHNSON, AYODEJI DAVID (MD)
Entity type:Individual
Prefix:
First Name:AYODEJI
Middle Name:DAVID
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 NEVINS STREET
Mailing Address - Street 2:ST. ELIZABETH MEDICAL CENTER MEDICAL OFFICE BUILDING, 3
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135
Mailing Address - Country:US
Mailing Address - Phone:617-789-2386
Mailing Address - Fax:
Practice Address - Street 1:11 NEVINS STREET
Practice Address - Street 2:ST. ELIZABETH MEDICAL CENTER MEDICAL OFFICE BUILDING, 3
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02135
Practice Address - Country:US
Practice Address - Phone:617-789-2386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-16
Last Update Date:2025-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program