Basic Information
| Provider Information | |||||||||
| NPI: | 1225116411 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOHNSTON | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | THOMAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1400 LOCUST ST | ||||||||
| Address2: | SUITE 5106 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124713061 | ||||||||
| FaxNumber: | 4124716621 | ||||||||
| Practice Location | |||||||||
| Address1: | 1400 LOCUST ST | ||||||||
| Address2: | SUITE 5106 | ||||||||
| City: | PITTSBURGH | ||||||||
| State: | PA | ||||||||
| PostalCode: | 152195114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4124713061 | ||||||||
| FaxNumber: | 4124716621 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/02/2006 | ||||||||
| LastUpdateDate: | 08/01/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | MD015363E | PA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 211217 | 01 | UPMC HEALTH PLAN | OTHER | 11130805 | 01 | TRAVELERS MEDICARE | OTHER | 05033 | 01 | UNITED MINEWORKERS | OTHER | 0107271650004 | 05 | PA | MEDICAID | 084865 | 01 | HIGHMARK | OTHER | 220102 | 01 | HEALTH AMERICA/ASSURANCE | OTHER | 483935 | 01 | US HEALTHCARE | OTHER |