Provider Demographics
NPI:1255870986
Name:D'AGATA, JOHN DANIEL JR (PA-C)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:DANIEL
Last Name:D'AGATA
Suffix:JR
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
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Mailing Address - Street 1:20 COUNTRY LN
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CT
Mailing Address - Zip Code:06095-3412
Mailing Address - Country:US
Mailing Address - Phone:860-324-3684
Mailing Address - Fax:
Practice Address - Street 1:114 WOODLAND ST
Practice Address - Street 2:SAINT FRANCIS HOSPITAL AND MEDICAL CENTER
Practice Address - City:HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06105-1208
Practice Address - Country:US
Practice Address - Phone:860-714-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-02-14
Last Update Date:2022-07-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CT3783363AS0400X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical