Provider Demographics
NPI:1447285366
Name:JOHNSON, DIANE (DPM)
Entity type:Individual
Prefix:
First Name:DIANE
Middle Name:
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4649
Mailing Address - Street 2:SUITE 670
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15206-0649
Mailing Address - Country:US
Mailing Address - Phone:412-362-9440
Mailing Address - Fax:412-362-9363
Practice Address - Street 1:5750 CENTRE AVE
Practice Address - Street 2:STE 190
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206-3761
Practice Address - Country:US
Practice Address - Phone:412-362-9440
Practice Address - Fax:412-362-9363
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2016-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC003241L213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA544061OtherHIGHMARKBCBS
PA0077581540001Medicaid
PA250813OtherUPMC
PA0077581540001Medicaid
PA544061Medicare PIN
PA250813OtherUPMC
PA480007566Medicare PIN