Provider Demographics
NPI:1548253669
Name:JOHNSON, DANIEL W (MD)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:W
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:111 NASON DR
Mailing Address - Street 2:STE 101
Mailing Address - City:ROARING SPRING
Mailing Address - State:PA
Mailing Address - Zip Code:16673-1212
Mailing Address - Country:US
Mailing Address - Phone:814-224-5132
Mailing Address - Fax:814-224-2903
Practice Address - Street 1:1060 LLOYD ST
Practice Address - Street 2:
Practice Address - City:NANTY GLO
Practice Address - State:PA
Practice Address - Zip Code:15943-1232
Practice Address - Country:US
Practice Address - Phone:814-749-8624
Practice Address - Fax:814-749-8248
Is Sole Proprietor?:No
Enumeration Date:2005-08-24
Last Update Date:2017-02-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD042798L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA585311Medicare ID - Type Unspecified
E89197Medicare UPIN