Provider Demographics
NPI:1396059119
Name:JOHNSON, SARAH CRANE (PA-C)
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:CRANE
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:901 W ASHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:GLENOLDEN
Mailing Address - State:PA
Mailing Address - Zip Code:19036-1101
Mailing Address - Country:US
Mailing Address - Phone:610-461-6450
Mailing Address - Fax:610-461-1842
Practice Address - Street 1:901 W ASHLAND AVE
Practice Address - Street 2:
Practice Address - City:GLENOLDEN
Practice Address - State:PA
Practice Address - Zip Code:19036-1310
Practice Address - Country:US
Practice Address - Phone:610-461-6450
Practice Address - Fax:610-461-1842
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2024-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA054375363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA201525YDMTMedicare PIN