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NPI Code Detail

MEDICARE: DR. ALLAN CHARLES JOHNSON JR. D.O.

MEDICARE: DR. ALLAN CHARLES JOHNSON JR. D.O.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine PhysicianOS005863LPA

General Provider Information

NPI Number : 1235132812
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ALLAN CHARLES JOHNSON JR. D.O.
Provider Business Mailing Address
First Line : 4950 BUFFALO RD
Second Line :
City : ERIE
State : PA
Zip : 16510-2304
Country : US
Telephone Number : 814-898-2576
Fax Number : 814-899-0334
Provider Business Practice Location Address
First Line : 4950 BUFFALO RD
Second Line :
City : ERIE
State : PA
Zip : 16510-2304
Country : US
Telephone Number : 814-898-2576
Fax Number : 814-899-0334
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/27/2005
Last Update Date : 10/05/2020

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