Provider Demographics
NPI:1023398302
Name:JOHNSON, MATTHEW ETHAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ETHAN
Last Name:JOHNSON
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:155 WELLNESS WAY
Mailing Address - Street 2:
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16803-6702
Mailing Address - Country:US
Mailing Address - Phone:814-231-7000
Mailing Address - Fax:814-231-7098
Practice Address - Street 1:164 GREENVIEW DR STE 345
Practice Address - Street 2:
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16803-2106
Practice Address - Country:US
Practice Address - Phone:814-234-7599
Practice Address - Fax:814-237-2126
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2025-09-26
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PA363A00000X
CT2609363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant