Individual
JERRY C JOHNSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3615 CHESTNUT ST, RALSTON PENN CENTER, PHILADELPHIA, PA 19104
(215) 662-2746
(215) 349-5648
Mailing address
3615 CHESTNUT ST, RALSTON PENN CENTER, PHILADELPHIA, PA 19104-2612
(215) 662-2746
(215) 349-5648
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD019829E
PA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
Primary
MD019829E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0007361000007
—
PA
Enumeration date
06/14/2006
Last updated
03/23/2012
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