Individual
TIMOTHY SHANE JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
30 HOPE DR STE 1860, HERSHEY, PA 17033-2036
(717) 531-8952
(717) 531-0098
Mailing address
PO BOX 858, MC A410, HERSHEY, PA 17033-0858
(800) 243-1455
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
MD424449
PA
2082S0105X
Surgery of the Hand (Plastic Surgery) Physician
MD424449
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016969880001
—
PA
Enumeration date
07/13/2006
Last updated
12/13/2019
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