Provider Demographics
NPI:1457635724
Name:JOHNSTON, SAMANTHA D (PA-C)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:D
Last Name:JOHNSTON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 INNOVATION WAY
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-7906
Mailing Address - Country:US
Mailing Address - Phone:724-981-1219
Mailing Address - Fax:
Practice Address - Street 1:3068 INNOVATION WAY
Practice Address - Street 2:
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-7906
Practice Address - Country:US
Practice Address - Phone:724-981-1219
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-05
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA055177363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical