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NPI Code Detail

MEDICARE: KRISTI JOHNSON DO

MEDICARE: KRISTI JOHNSON DO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS010187LPA

General Provider Information

NPI Number : 1588656060
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTI JOHNSON DO
Provider Business Mailing Address
First Line : 2840 W DAUPHIN ST
Second Line :
City : PHILA
State : PA
Zip : 19132-4627
Country : US
Telephone Number : 215-685-3405
Fax Number : 215-685-2440
Provider Business Practice Location Address
First Line : 2840 W DAUPHIN ST
Second Line :
City : PHILA
State : PA
Zip : 19132-4627
Country : US
Telephone Number : 215-685-3405
Fax Number : 215-685-2440
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/19/2005
Last Update Date : 12/10/2007

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