Provider Demographics
NPI:1417932138
Name:JOHNSON, ROBERT P (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
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 1:676 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW HOLLAND
Mailing Address - State:PA
Mailing Address - Zip Code:17557-1426
Mailing Address - Country:US
Mailing Address - Phone:717-354-4671
Mailing Address - Fax:717-354-2478
Practice Address - Street 1:676 E MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW HOLLAND
Practice Address - State:PA
Practice Address - Zip Code:17557-1426
Practice Address - Country:US
Practice Address - Phone:717-354-4671
Practice Address - Fax:717-354-2478
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2007-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD012614E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA01638801OtherCAPITAL BLUE CROSS
PA5976102OtherAETNA NON-HMO
PAD71285OtherHEALTH ASSURANCE
PA40489 S1QIOtherGEISINGER HEALTH PLAN
PA146265OtherHIGHMARK BLUE SHIELD
PA0006735920001Medicaid
PAP002646OtherGATEWAY HEALTH PLAN
PA533060OtherAETNA HMO
PAD71285OtherHEALTH ASSURANCE
PA40489 S1QIOtherGEISINGER HEALTH PLAN
PA146265G21Medicare PIN
PA5976102OtherAETNA NON-HMO
PA146265OtherHIGHMARK BLUE SHIELD