Provider Demographics
NPI:1225004336
Name:JOHNSON, LYNNE M (MD)
Entity Type:Individual
Prefix:DR
First Name:LYNNE
Middle Name:M
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:100 SHENANGO AVENUE
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-0716
Mailing Address - Country:US
Mailing Address - Phone:724-588-5250
Mailing Address - Fax:724-588-5253
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2608
Practice Address - Country:US
Practice Address - Phone:724-588-5250
Practice Address - Fax:724-588-5253
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2017-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD421255208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0019567800002Medicaid
PA070947RN0Medicare PIN
PA0019567800002Medicaid