Provider Demographics
NPI:1568436921
Name:JOHNSON, RICHARD B (MD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:B
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 1:120 LYTTON AVE
Mailing Address - Street 2:SUITE M059
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-1481
Mailing Address - Country:US
Mailing Address - Phone:412-623-8905
Mailing Address - Fax:412-623-8906
Practice Address - Street 1:120 LYTTON AVE
Practice Address - Street 2:SUITE M059
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-1481
Practice Address - Country:US
Practice Address - Phone:412-623-8905
Practice Address - Fax:412-623-8906
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2016-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD030965E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD71078Medicare UPIN
PA031358PD8Medicare ID - Type Unspecified