Provider Demographics
NPI:1689638116
Name:JOHNSON, JOANNA R (MD)
Entity Type:Individual
Prefix:DR
First Name:JOANNA
Middle Name:R
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5501 OLD YORK RD
Mailing Address - Street 2:LEVY 2 WEST
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3018
Mailing Address - Country:US
Mailing Address - Phone:215-456-6786
Mailing Address - Fax:
Practice Address - Street 1:5501 OLD YORK RD
Practice Address - Street 2:LEVY 2 WEST
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19141-3018
Practice Address - Country:US
Practice Address - Phone:215-456-6786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-13
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017088E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA856289OtherAETNA HMO PROVIDER #
PA1031512OtherKEYSTONE MERCY PROVIDER #
PA232295464OtherCIGNA PPO PROVIDER #
PA136289OtherINDEPENDENCE B/C PROVIDER
PA232295464OtherAETNA PPO PROVIDER#
PA0046132000OtherKEYSTONE HMO PROVIDER #
PA1290835006OtherCIGNA HMO PROVIDER #
PA136289OtherHIGHMARK PROVIDER #
PA136289Medicare ID - Type UnspecifiedPROVIDER IDENTIFICATION #
PAC31354Medicare UPIN