Healthcare Provider Details

I. General information

NPI: 1871580399
Provider Name (Legal Business Name): STEVE ELEFTHERIS VACALIS D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/30/2005
Last Update Date: 07/18/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2711 X RAY DR
GASTONIA NC
28054-7491
US

IV. Provider business mailing address

2711 X RAY DR
GASTONIA NC
28054-7491
US

V. Phone/Fax

Practice location:
  • Phone: 704-834-2420
  • Fax: 704-834-2426
Mailing address:
  • Phone: 704-834-2420
  • Fax: 704-834-2426

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number9901066
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: