Provider Demographics
NPI:1528028420
Name:JOHNSON, CRAIG H (MD)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:H
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 1:601 SPRUCE ST
Mailing Address - Street 2:
Mailing Address - City:WEST READING
Mailing Address - State:PA
Mailing Address - Zip Code:19611-1443
Mailing Address - Country:US
Mailing Address - Phone:610-375-4567
Mailing Address - Fax:610-685-8801
Practice Address - Street 1:601 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611-1443
Practice Address - Country:US
Practice Address - Phone:610-375-4567
Practice Address - Fax:610-685-8801
Is Sole Proprietor?:No
Enumeration Date:2006-03-24
Last Update Date:2013-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD015662E207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA490633OtherAETNA PPO
PAP00730454OtherRAILROAD ID
PA01400001OtherCAPITAL BLUE CROSS
PA5554OtherHEALTH AMERICA
PA022036R1XOtherMEDICARE ID
PA022036OtherHIGHMARK BLUE SHIELD
PA455952OtherAETNA HMO
PA478220001OtherHEALTH NOW NY INC
PA0007408000001Medicaid
PA116567600OtherUS DEPARTMENT OF LABOR
PA116567600OtherUS DEPARTMENT OF LABOR