Provider Demographics
NPI:1205858024
Name:JOHNSON, ROBERT ALAN (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:ALAN
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 1:111 WHEATFIELD DR STE 2
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:PA
Mailing Address - Zip Code:18337-7837
Mailing Address - Country:US
Mailing Address - Phone:570-296-1003
Mailing Address - Fax:570-296-2981
Practice Address - Street 1:111 WHEATFIELD DR
Practice Address - Street 2:SUITE 2
Practice Address - City:MILFORD
Practice Address - State:PA
Practice Address - Zip Code:18337-7697
Practice Address - Country:US
Practice Address - Phone:570-296-1003
Practice Address - Fax:570-296-2981
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2019-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY206842207R00000X, 207RP1001X
PAMD061877L207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA535982OtherBSPA
NJ7856504Medicaid
GA290010470OtherMEDICARE RR
NY01753126Medicaid
PA0952790PN3OtherMEDICARE PA
GA290010470OtherMEDICARE RR
NJ7856504Medicaid