Healthcare Provider Details

I. General information

NPI: 1982976783
Provider Name (Legal Business Name): ELIZABETH ALLISON VACCARO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/08/2012
Last Update Date: 02/08/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 NEW JERSEY AVE SE APT 1210
WASHINGTON DC
20003-3312
US

IV. Provider business mailing address

1000 NEW JERSEY AVE SE APT 1210
WASHINGTON DC
20003-3312
US

V. Phone/Fax

Practice location:
  • Phone: 410-279-5702
  • Fax:
Mailing address:
  • Phone: 410-279-5702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU01967
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: