Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | MD425522 | PA |
NPI | 1003898131 |
---|---|
Provider Name | Mark H Johnston |
First Address | Lancaster, PA 17601-2644 |
Second Address | Lancaster, PA 17601-2644 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/11/2005 |
Last Update Date | 13/06/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
093677KKU | MEDICARE (01) | PA |
1012082120002 | (05) | PA |
1012082120004 | (05) | PA |
1012082120005 | (05) | PA |
I38463 | (02) | PA |
P01832235 | RR MEDICARE (01) | PA |