Healthcare Provider Details

I. General information

NPI: 1700078730
Provider Name (Legal Business Name): JENNIFER JOHNSON M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/14/2007
Last Update Date: 04/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3811 OHARA ST
PITTSBURGH PA
15213-2593
US

IV. Provider business mailing address

3811 OHARA ST
PITTSBURGH PA
15213-2593
US

V. Phone/Fax

Practice location:
  • Phone: 412-563-5777
  • Fax: 412-563-0122
Mailing address:
  • Phone: 412-563-5777
  • Fax: 412-563-0122

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberMD432922
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: