Provider Demographics
NPI:1801860267
Name:JOHNSTON, JAMES R (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:R
Last Name:JOHNSTON
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 1:3459 5TH AVE
Mailing Address - Street 2:9 SOUTH MUH
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3236
Mailing Address - Country:US
Mailing Address - Phone:412-647-2561
Mailing Address - Fax:
Practice Address - Street 1:3459 5TH AVE
Practice Address - Street 2:9 SOUTH MUH
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3236
Practice Address - Country:US
Practice Address - Phone:412-647-2561
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-14
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD024198E174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA000860559Medicaid
PAC29267Medicare UPIN
PA000860559Medicaid