Healthcare Provider Details

I. General information

NPI: 1578747614
Provider Name (Legal Business Name): GYNECOLOGIC ONCOLOGY AND PELVIC SURGERY ASSOCIATES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/26/2007
Last Update Date: 12/27/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 W STATE ST SUITE 550A
COLUMBUS OH
43222-1515
US

IV. Provider business mailing address

745 W STATE ST SUITE 550A
COLUMBUS OH
43222-1515
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: LUIS VACCARELLO
Title or Position: PHYSICIAN
Credential: MD
Phone: 614-383-6000