MEDICARE: DR. GARY E. JOHNSON

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
1	207Q00000X	Family Medicine Physician	MD023539E	PA

General Provider Information

NPI Number	:	1508868233
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GARY E. JOHNSON

Provider Business Mailing Address
First Line	:	3005 BANKSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2718
Country	:	US
Telephone Number	:	412-942-0702
Fax Number	:	412-942-0733

Provider Business Practice Location Address
First Line	:	3005 BANKSVILLE RD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15216-2718
Country	:	US
Telephone Number	:	412-942-0702
Fax Number	:	412-942-0733

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2005
Last Update Date	:	10/07/2020

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