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General NPI Number Information
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NPI Number | 1477295244
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Entity Type | Individual
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Provider Name | CRAIG TYRRELL JOHNSTON JR. DO
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Gender | Male
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Dates
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Enumeration Date | 04/11/2022
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Last Update Date | 06/18/2025
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Provider Practice Location Address
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Address Line | 3535 PINE AVE
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City | ERIE
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State | PA
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Zip | 16504-1743
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Country | US
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Telephone | 814-877-7260
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Fax |
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Provider Business Mailing Address
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Address Line | 2421 W 36TH ST
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City | ERIE
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State | PA
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Zip | 16506-3565
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Country | US
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Telephone | 814-490-6351
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number | OT021452
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | OS024777
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License Number State | PA
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