Provider Demographics
NPI:1902895782
Name:JOHNSON, PAUL COLONIUS IV (MD)
Entity type:Individual
Prefix:DR
First Name:PAUL
Middle Name:COLONIUS
Last Name:JOHNSON
Suffix:IV
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:3998 RED LION RD STE 211
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19114-1440
Mailing Address - Country:US
Mailing Address - Phone:215-612-5390
Mailing Address - Fax:215-612-5658
Practice Address - Street 1:3998 RED LION RD STE 211
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19114-1440
Practice Address - Country:US
Practice Address - Phone:215-612-5390
Practice Address - Fax:215-612-5658
Is Sole Proprietor?:No
Enumeration Date:2005-10-14
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NV11580207Y00000X
PATMD004517207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VABJ7220926OtherDEA