Healthcare Provider Details

I. General information

NPI: 1619173135
Provider Name (Legal Business Name): NEPHROLOGY ASSOCIATES OF MONTGOMERY COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 04/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6240 MONTROSE RD
ROCKVILLE MD
20852-4114
US

IV. Provider business mailing address

6240 MONTROSE RD
ROCKVILLE MD
20852-4114
US

V. Phone/Fax

Practice location:
  • Phone: 301-231-7111
  • Fax: 301-231-9040
Mailing address:
  • Phone: 301-231-7111
  • Fax: 301-231-9040

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. STEPHEN GAETANO VACCAREZZA
Title or Position: PRESIDENT
Credential: MD
Phone: 301-231-7111