Provider Demographics
NPI:1659639805
Name:DWIGHT C JOHNSON DO PC
Entity Type:Organization
Organization Name:DWIGHT C JOHNSON DO PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:C
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:610-344-7703
Mailing Address - Street 1:419 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2400
Mailing Address - Country:US
Mailing Address - Phone:610-344-7703
Mailing Address - Fax:610-344-7797
Practice Address - Street 1:419 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19380-2400
Practice Address - Country:US
Practice Address - Phone:610-344-7703
Practice Address - Fax:610-344-7797
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-25
Last Update Date:2012-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS-007597-L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty