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NPI Code Detail

MEDICARE: DR. TIMOTHY DAVID JOHNSTON M.D.

MEDICARE: DR. TIMOTHY DAVID JOHNSTON M.D.
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
1207R00000XInternal Medicine PhysicianMD429536PA
2208000000XPediatrics PhysicianMD429536PA

General Provider Information

NPI Number : 1760416242
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. TIMOTHY DAVID JOHNSTON M.D.
Provider Business Mailing Address
First Line : 4417 N 6TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-2319
Country : US
Telephone Number : 215-302-3150
Fax Number : 215-329-2369
Provider Business Practice Location Address
First Line : 4417 N 6TH ST
Second Line :
City : PHILADELPHIA
State : PA
Zip : 19140-2319
Country : US
Telephone Number : 215-302-3150
Fax Number : 215-329-2369
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/10/2006
Last Update Date : 11/19/2014

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