Organization
VAN W. JOHNSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SUSAN NORDIN (MANAGER)
(814) 726-1921
Entity
Organization
Contact information
Practice address
103 W SAINT CLAIR ST, WARREN, PA 16365-2197
(814) 726-1921
(814) 726-7881
Mailing address
103 W SAINT CLAIR ST, WARREN, PA 16365-2197
(814) 726-1921
(814) 726-7881
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD013857E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
105684
BLUE SHIELD INDIVIDUAL
PA
01
—
1938251
BLUE SHIELD GROUP
PA
Enumeration date
03/29/2007
Last updated
08/22/2020
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