Healthcare Provider Details

I. General information

NPI: 1457417875
Provider Name (Legal Business Name): KIRSTEN HOPE JOHNSEN MARTIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/29/2006
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

540 N DUKE ST
LANCASTER PA
17602-2374
US

IV. Provider business mailing address

555 N. DUKE ST. PO BOX 3555
LANCASTER PA
17604-3555
US

V. Phone/Fax

Practice location:
  • Phone: 717-544-4950
  • Fax: 717-544-5964
Mailing address:
  • Phone: 717-544-4940
  • Fax: 717-544-2690

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOS014047
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: