Individual
ROBERT W JOHANSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
201 STATE ST, HAMOT FACULTY SPECIALISTS, ERIE, PA 16550-0002
(814) 877-4922
(814) 877-3622
Mailing address
717 STATE ST, SUITE 16, LL, ERIE, PA 16501-1341
(814) 877-7100
(814) 877-2939
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
MD013856E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0006028030005
—
PA
01
—
044058
BLUE SHIELD
PA
01
—
110694
UNISON
PA
01
—
P00170489
RR MEDICARE
PA
Enumeration date
10/12/2005
Last updated
05/22/2012
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