Healthcare Provider Details

I. General information

NPI: 1598738833
Provider Name (Legal Business Name): DWIGHT C JOHNSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2006
Last Update Date: 01/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N. FRANKLIN STREET SUITE 3
WEST CHESTER PA
19380-4435
US

IV. Provider business mailing address

419 N. FRANKLIN STREET SUITE 3
WEST CHESTER PA
19380-4435
US

V. Phone/Fax

Practice location:
  • Phone: 610-344-7703
  • Fax: 610-344-7797
Mailing address:
  • Phone: 610-344-7703
  • Fax: 610-344-7797

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberOS007597L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: