Healthcare Provider Details

I. General information

NPI: 1659639805
Provider Name (Legal Business Name): DWIGHT C JOHNSON DO PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 04/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

419 N FRANKLIN ST
WEST CHESTER PA
19380-2400
US

IV. Provider business mailing address

419 N FRANKLIN ST
WEST CHESTER PA
19380-2400
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 NumberOS-007597-L
License Number StatePA

VIII. Authorized Official

Name: DR. DWIGHT C JOHNSON
Title or Position: CEO
Credential: D.O.
Phone: 610-344-7703