Provider Demographics
NPI:1184693608
Name:JOHNSTON, PETER EDWIN (DO)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:EDWIN
Last Name:JOHNSTON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5350 FRANTZ RD
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-4259
Mailing Address - Country:US
Mailing Address - Phone:614-544-6355
Mailing Address - Fax:614-544-6350
Practice Address - Street 1:5131 BEACON HILL RD
Practice Address - Street 2:SUITE 160
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228-4442
Practice Address - Country:US
Practice Address - Phone:614-544-1837
Practice Address - Fax:614-544-2816
Is Sole Proprietor?:No
Enumeration Date:2006-03-16
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34 00 1146207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0048095Medicaid
D89838Medicare UPIN
OHJO0010347Medicare PIN