Provider Demographics
NPI:1679537138
Name:JOHNSTON, CRAIG T (DO)
Entity Type:Individual
Prefix:DR
First Name:CRAIG
Middle Name:T
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3535 PINE AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1743
Mailing Address - Country:US
Mailing Address - Phone:814-454-3363
Mailing Address - Fax:814-454-4945
Practice Address - Street 1:3535 PINE AVE
Practice Address - Street 2:1ST FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16504-1743
Practice Address - Country:US
Practice Address - Phone:814-454-3363
Practice Address - Fax:814-454-4945
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004812L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAD68696Medicare UPIN
PA024499Medicare ID - Type Unspecified