Individual
JOHN P IMPASTATO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
325 CHARLES H DIMMOCK PKWY STE 100, COLONIAL HEIGHTS, VA 23834-2986
(804) 526-5888
(804) 526-5401
Mailing address
325 CHARLES H DIMMOCK PKWY STE 100, COLONIAL HEIGHTS, VA 23834-2986
(804) 526-5888
(804) 526-5401
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0110004196
VA
363A00000X
Physician Assistant
1746
OH
363A00000X
Physician Assistant
C06773
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1053319590
—
VA
Enumeration date
07/08/2005
Last updated
07/24/2020
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