Healthcare Provider Details

I. General information

NPI: 1649595380
Provider Name (Legal Business Name): SARAH JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2010
Last Update Date: 06/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 E CHELTEN AVE
PHILADELPHIA PA
19144-2153
US

IV. Provider business mailing address

131 E CHELTEN AVE
PHILADELPHIA PA
19144-2153
US

V. Phone/Fax

Practice location:
  • Phone: 215-685-5745
  • Fax:
Mailing address:
  • Phone: 215-685-5745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMT196815
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: