Active NPI
Calvin B Johnson, MD
- Pediatrics Physician
- Philadelphia, PA
National Provider Identifier
1669790499
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- MD056719L
- Practice address
- 3509 N Broad St
Philadelphia, PA 19140-4105 - Phone
- (215) 707-5437
- Fax
- (215) 707-5180
- NPI assigned
- May 4, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | MD056719L | PA | Primary |
Addresses
Primary practice location
3509 N Broad St
Philadelphia, PA 19140-4105
Mailing address
2450 West Hunting Park Avenue
Tasb
Philadelphia, PA 19129
Phone (215) 707-8561
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MD056719L | PA | MD | Pediatrics Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1272931200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1273190400000",
"number": "1669790499",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2450 WEST HUNTING PARK AVENUE",
"address_2": "TASB",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "19129",
"telephone_number": "215-707-8561",
"fax_number": "215-707-3677"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3509 N BROAD ST",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191404105",
"telephone_number": "215-707-5437",
"fax_number": "215-707-5180"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "CALVIN",
"middle_name": "B",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-05-04",
"last_updated": "2010-05-07",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "PA",
"license": "MD056719L",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 7, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.