Provider Demographics
NPI:1164597456
Name:JOHNSON, ADRIENNE RUTH (MD)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:RUTH
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4870 LIBHART MILL RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17406
Mailing Address - Country:US
Mailing Address - Phone:717-757-3464
Mailing Address - Fax:717-600-2364
Practice Address - Street 1:1930 SECURITY DRIVE
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17402
Practice Address - Country:US
Practice Address - Phone:717-741-4641
Practice Address - Fax:717-741-9198
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD 066 211L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
H03676Medicare UPIN
H03676Medicare UPIN