Provider Demographics
NPI:1801209713
Name:JOHNSON, MATTHEW (DO)
Entity type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4524 WOODLAWN DR
Mailing Address - Street 2:
Mailing Address - City:EMMAUS
Mailing Address - State:PA
Mailing Address - Zip Code:18049-1250
Mailing Address - Country:US
Mailing Address - Phone:423-552-6587
Mailing Address - Fax:
Practice Address - Street 1:920 CHURCH STREET
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:PA
Practice Address - Zip Code:17042
Practice Address - Country:US
Practice Address - Phone:717-272-2700
Practice Address - Fax:717-272-2757
Is Sole Proprietor?:No
Enumeration Date:2014-06-09
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SCLL36689207Q00000X
PAOS019404207Q00000X
VA0102207758207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine