Provider Demographics
NPI:1376962316
Name:IMPASTATO, KATHERINE ACCARDO (MD)
Entity type:Individual
Prefix:
First Name:KATHERINE
Middle Name:ACCARDO
Last Name:IMPASTATO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13317 NE 12TH AVE STE 107
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2731
Mailing Address - Country:US
Mailing Address - Phone:360-350-4794
Mailing Address - Fax:
Practice Address - Street 1:13317 NE 12TH AVE STE 107
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2731
Practice Address - Country:US
Practice Address - Phone:360-350-4794
Practice Address - Fax:360-589-5491
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-07
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60660093208200000X, 2086S0122X
WV297912086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery