Basic Information
| Provider Information | |||||||||
| NPI: | 1164597456 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JOHNSON | ||||||||
| FirstName: | ADRIENNE | ||||||||
| MiddleName: | RUTH | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4870 LIBHART MILL RD | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17406 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177573464 | ||||||||
| FaxNumber: | 7176002364 | ||||||||
| Practice Location | |||||||||
| Address1: | 1930 SECURITY DRIVE | ||||||||
| Address2: | |||||||||
| City: | YORK | ||||||||
| State: | PA | ||||||||
| PostalCode: | 17402 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7177414641 | ||||||||
| FaxNumber: | 7177419198 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/21/2006 | ||||||||
| LastUpdateDate: | 09/11/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD 066 211L | PA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.