Provider Demographics
NPI:1902883606
Name:JOHNSON, WILLIAM THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:THOMAS
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:170 WHITEHALL RD
Mailing Address - Street 2:
Mailing Address - City:REINHOLDS
Mailing Address - State:PA
Mailing Address - Zip Code:17569-9549
Mailing Address - Country:US
Mailing Address - Phone:717-336-5711
Mailing Address - Fax:
Practice Address - Street 1:READING ANESTHESIA ASSOCIATES
Practice Address - Street 2:6TH AVE. & SPRUCE ST.
Practice Address - City:WEST READING
Practice Address - State:PA
Practice Address - Zip Code:19611
Practice Address - Country:US
Practice Address - Phone:610-988-8589
Practice Address - Fax:610-988-5976
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD017103E207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA598326Medicaid
PAC27900Medicare UPIN
PAJ0028834Medicare ID - Type Unspecified