Provider Demographics
NPI:1124057625
Name:JOHNSON, DEAN E (MD)
Entity type:Individual
Prefix:
First Name:DEAN
Middle Name:E
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 1:640 S. STATE STREET
Mailing Address - Street 2:MAIL CODE 3055
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19901-3530
Mailing Address - Country:US
Mailing Address - Phone:302-480-1688
Mailing Address - Fax:302-480-9807
Practice Address - Street 1:640 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-3530
Practice Address - Country:US
Practice Address - Phone:302-744-6156
Practice Address - Fax:302-735-3845
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2021-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD053758L207P00000X
DEC1-0024532207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA50067224OtherCAPITAL BLUE CROSS-YH
PA169286OtherUNISON-YH
PA79947OtherGEISINGER-YH
PA892272OtherHIGHMARK BLUE SHIELD-YH
PA20038410OtherAMERIHEALTH MERCY-YH
PA0806464000OtherAMERIHEALTH 65 PA-YH
PA001479947Medicaid
PA1544537OtherGATEWAY-YH
PA0806464000OtherAMERIHEALTH 65 PA-YH
PA169286OtherUNISON-YH
PA79947OtherGEISINGER-YH