Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | MD431679 | PA |
N | 111NI0900X | Internist | MD431679 | PA |
Y | 207RC0200X | Critical Care Medicine | MD431679 | PA |
NPI | 1053367268 |
---|---|
Provider Name | Cheilonda R Johnson |
First Address | Philadelphia, PA 19104-5161 |
Second Address | Philadelphia, PA 19104-5161 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2006 |
Last Update Date | 14/10/2019 |