Provider Demographics
NPI:1710859103
Name:D'AMATO, LAURA JOSEPHINE (PA-C)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:JOSEPHINE
Last Name:D'AMATO
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 1:18 PEAR ST
Mailing Address - Street 2:
Mailing Address - City:BARNESVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:18214-2401
Mailing Address - Country:US
Mailing Address - Phone:570-789-3573
Mailing Address - Fax:
Practice Address - Street 1:143 N RAILROAD ST
Practice Address - Street 2:
Practice Address - City:TAMAQUA
Practice Address - State:PA
Practice Address - Zip Code:18252-1330
Practice Address - Country:US
Practice Address - Phone:570-645-1540
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-09-23
Last Update Date:2025-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA067129363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant