Provider Demographics
NPI:1609002195
Name:JOHNSON, BRIAN M (MD)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:M
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 1:4727 FRIENDSHIP AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1778
Mailing Address - Country:US
Mailing Address - Phone:412-235-5810
Mailing Address - Fax:412-235-5890
Practice Address - Street 1:4727 FRIENDSHIP AVE STE 200
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15224-1778
Practice Address - Country:US
Practice Address - Phone:412-235-5810
Practice Address - Fax:412-235-5890
Is Sole Proprietor?:No
Enumeration Date:2009-06-10
Last Update Date:2020-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD436252207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1023368990001Medicaid
PA155240NHMMedicare PIN