Provider Demographics
NPI:1366431405
Name:IADEROSA, JOHN F (PA)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:F
Last Name:IADEROSA
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Mailing Address - Street 1:4 E JACKSON BLVD
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-5810
Mailing Address - Country:US
Mailing Address - Phone:912-355-1010
Mailing Address - Fax:912-354-1441
Practice Address - Street 1:4 E JACKSON BLVD
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-5810
Practice Address - Country:US
Practice Address - Phone:912-355-1010
Practice Address - Fax:912-354-1441
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00008489BMedicaid
GA97BBHHTMedicare ID - Type Unspecified
P43684Medicare UPIN