Bertram Lee Johnson Jr., MD
Individual provider Active NPI Cardiovascular Disease Physician · Lancaster, PA
NPI 1477588218 · NPPES record last updated Feb 5, 2018
Key facts
- NPI
- 1477588218
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Cardiovascular Disease Physician 207RC0000X
- License
- MD012613E (PA)
- Practice address
- 1821 Oregon Pike Ste 2
Lancaster, PA 17601-6466 - Phone
- (717) 569-7100
- Fax
- (717) 569-3011
- NPI assigned
- Jul 11, 2006
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- HHS exclusion list flag
- The National Provider Directory flags this NPI as appearing on an HHS exclusion list.
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD012613E | PA | MD | Cardiovascular Disease Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Urgent Care Center of Lancaster, LLC | Single Specialty | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist |
174400000X | MD012613E | PA | |
| Cardiovascular Disease Physician | 207RC0000X | MD012613E | PA | Yes |
Addresses
Primary practice location
1821 Oregon Pike Ste 2
Lancaster, PA 17601-6466
Mailing address
1821 Oregon Pike Ste 2
Lancaster, PA 17601-6466
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000602572 | Medicaid | PA | |
| 233072995 | Other | PA | TID |
Other providers in Lancaster, PA
- Jarod Biju John
- Alyson Johns
- Jeannie Johns
- Kirsten Hope Johnsen Martin
- Rae Denise Johnson-Bundy
- Brenda Kay Johnson
- Brent Christian Johnson
- Ellen Johnson
- Jayona Johnson
- Jermel Johnson
All providers in Lancaster, PA · Cardiovascular Disease Physician in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.