Doctor Name: | JUSTIN JOHNSON |
NPI Number: | 1962822593 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | DO |
License Number: | OT015814 |
Business Practice Address: | 4300 Londonderry Rd Harrisburg, PA - 171095317 |
Business Phone Number: | 7176577522 |
Business Fax Number: | |
Mailing Address: | 4300 Londonderry Rd, HARRISBURG |
State: | PA |
Postal Code: | 171095317 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 04/22/2014 |
NPI Last Update Date: | 07/21/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 390200000X |
License Number: | OT015814 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | PA |
Taxonomy Type: | Student, Health Care |
Taxonomy Classification: | Student in an Organized Health Care Education/Training Program |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care. |