Individual
DR. BERTRAM LEE JOHNSON JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1821 OREGON PIKE STE 2, LANCASTER, PA 17601-6466
(717) 569-7100
(717) 569-3011
Mailing address
1821 OREGON PIKE STE 2, LANCASTER, PA 17601-6466
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
MD012613E
PA
207RC0000X
Cardiovascular Disease Physician
Primary
MD012613E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000602572
—
PA
01
—
233072995
TID
PA
Enumeration date
07/11/2006
Last updated
02/05/2018
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