Provider Demographics
NPI:1689980294
Name:D'AGOSTINO, JOHANNA PATRICIA (MD)
Entity type:Individual
Prefix:DR
First Name:JOHANNA
Middle Name:PATRICIA
Last Name:D'AGOSTINO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:JOHANNA
Other - Middle Name:PATRICIA
Other - Last Name:SERRANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:950 WOODLAND ST
Mailing Address - Street 2:
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-4373
Mailing Address - Country:US
Mailing Address - Phone:717-988-8020
Mailing Address - Fax:717-221-5567
Practice Address - Street 1:950 WOODLAND ST
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055
Practice Address - Country:US
Practice Address - Phone:717-988-8020
Practice Address - Fax:717-221-5567
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-20
Last Update Date:2021-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2874192086S0122X
PAMD452562282N00000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No282N00000XHospitalsGeneral Acute Care Hospital