Healthcare Provider Details

I. General information

NPI: 1225004336
Provider Name (Legal Business Name): LYNNE M JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/28/2006
Last Update Date: 06/09/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

348 MAIN ST
GREENVILLE PA
16125-2608
US

IV. Provider business mailing address

PO BOX 716 100 SHENANGO AVENUE
SHARON PA
16146-0716
US

V. Phone/Fax

Practice location:
  • Phone: 724-588-5250
  • Fax: 724-588-5253
Mailing address:
  • Phone: 724-588-5250
  • Fax: 724-588-5253

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberMD421255
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: