Provider Demographics
NPI:1710278320
Name:JOHNSON, THOMAS DUANE (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DUANE
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 1:2330 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17408-4107
Mailing Address - Country:US
Mailing Address - Phone:717-764-2823
Mailing Address - Fax:
Practice Address - Street 1:2330 BIRCH RD
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17408-4107
Practice Address - Country:US
Practice Address - Phone:717-764-2823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI33926-020208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice