Malcolm A Johnston IV

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

Practice address

133 N River St
Wilkes Barre, PA 18711-0800

Phone

(570) 208-5900

NPI assigned

Sep 11, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other names 1

• Mr. Malcolm A Johnston IV Professional name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• King'S College

  • Student Health Clinic/Center
  • Wilkes Barre, PA
  • NPI 1164749966
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1505088000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1505088000000",
    "number": "1952820912",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "133 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110800"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 N RIVER ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187110800",
            "telephone_number": "570-208-5900"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JOHNSTON",
        "first_name": "MALCOLM",
        "middle_name": "A",
        "name_suffix": "IV",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-09-11",
        "last_updated": "2017-09-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": false
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MALCOLM",
            "last_name": "JOHNSTON",
            "middle_name": "A",
            "prefix": "MR.",
            "suffix": "IV",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• John Heinz Institute of Rehabilitation Medicine
• John M. Prater
• John S Zavacki, M.D.,P.C.
• Daniel Johnson, PHYSICAL THERAPIST
• Theresa Johnson, LPC
• Ann Jones, R.N.
• Carolanne Jones, LCSW
• Sabrina Kayla Jones, O.D.
• Valerie Joy Jones, PHARM.D
• Jaclyn Jordan, MD

• Athletic Trainer in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Athletic Trainer in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.