Provider Demographics
NPI:1255504593
Name:DIANE JOHNSON DPM
Entity Type:Organization
Organization Name:DIANE JOHNSON DPM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:412-362-9440
Mailing Address - Street 1:211 N WHITFIELD ST
Mailing Address - Street 2:STE 670
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-3039
Mailing Address - Country:US
Mailing Address - Phone:412-362-9440
Mailing Address - Fax:412-362-9363
Practice Address - Street 1:211 N WHITFIELD ST
Practice Address - Street 2:STE 670
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3039
Practice Address - Country:US
Practice Address - Phone:412-362-9440
Practice Address - Fax:412-362-9363
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003241L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA544061OtherHIGHMARK BCBS
PA0077581540001Medicaid
PA0077581540001Medicaid
PA544061Medicare PIN