Provider Demographics
NPI:1831532563
Name:JOHNSON, ALAN WRIGHT SR (MD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:WRIGHT
Last Name:JOHNSON
Suffix:SR
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 1:6774 STONE CROFT CIR
Mailing Address - Street 2:
Mailing Address - City:MACUNGIE
Mailing Address - State:PA
Mailing Address - Zip Code:18062-9210
Mailing Address - Country:US
Mailing Address - Phone:610-967-2548
Mailing Address - Fax:
Practice Address - Street 1:6774 STONE CROFT CIR
Practice Address - Street 2:
Practice Address - City:MACUNGIE
Practice Address - State:PA
Practice Address - Zip Code:18062-9210
Practice Address - Country:US
Practice Address - Phone:610-967-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-11
Last Update Date:2013-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017823E208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC31100Medicare UPIN