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General NPI Number Information
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NPI Number | 1497989305
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Entity Type | Individual
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Provider Name | CLARK TIMOTHY JOHNSON MD
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Gender | Male
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Dates
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Enumeration Date | 05/06/2009
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Last Update Date | 07/07/2025
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Provider Practice Location Address
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Address Line | 100 S 2ND ST STE 4B
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City | HARRISBURG
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State | PA
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Zip | 17101-2546
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Country | US
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Telephone | 717-231-8472
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Fax | 717-231-8490
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Provider Business Mailing Address
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Address Line | 100 S 2ND ST STE 4B
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City | HARRISBURG
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State | PA
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Zip | 17101-2546
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Country | US
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Telephone | 717-231-8472
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Fax | 717-231-8490
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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 | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | D76370
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207V00000X
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Taxonomy Name | Obstetrics & Gynecology Physician
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License Number | MD490154
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 207VM0101X
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Taxonomy Name | Maternal & Fetal Medicine Physician
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License Number | MD490154
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License Number State | PA
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