Healthcare Provider Details

I. General information

NPI: 1336039734
Provider Name (Legal Business Name): BRIAN JOSEPH DAMATO FNP-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2025
Last Update Date: 10/15/2025
Certification Date: 10/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 POCAHONTAS TRL
QUINTON VA
23141-1657
US

IV. Provider business mailing address

815 PORTER ST APT 318
RICHMOND VA
23224-2273
US

V. Phone/Fax

Practice location:
  • Phone: 804-932-4388
  • Fax:
Mailing address:
  • Phone: 757-672-8539
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024193952
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: