Provider Demographics
NPI:1790840270
Name:PHILIP E. P. JOHNSON, MD, PC
Entity Type:Organization
Organization Name:PHILIP E. P. JOHNSON, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:E P
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:610-543-8888
Mailing Address - Street 1:127 LINDEN AVE
Mailing Address - Street 2:
Mailing Address - City:RUTLEDGE
Mailing Address - State:PA
Mailing Address - Zip Code:19070-2102
Mailing Address - Country:US
Mailing Address - Phone:610-543-8888
Mailing Address - Fax:
Practice Address - Street 1:127 LINDEN AVE
Practice Address - Street 2:
Practice Address - City:RUTLEDGE
Practice Address - State:PA
Practice Address - Zip Code:19070-2102
Practice Address - Country:US
Practice Address - Phone:610-543-8888
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD026166E207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty