Provider Demographics
NPI:1508278052
Name:JOHNSON, KAREN TERESA (DO)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:TERESA
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:690 LINCOLN HIGHWAY
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341
Mailing Address - Country:US
Mailing Address - Phone:610-873-5437
Mailing Address - Fax:856-968-9598
Practice Address - Street 1:401 HADDON AVE
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08103-1505
Practice Address - Country:US
Practice Address - Phone:856-757-7904
Practice Address - Fax:856-968-9598
Is Sole Proprietor?:No
Enumeration Date:2014-06-02
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
PAOS18982208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program