Healthcare Provider Details

I. General information

NPI: 1225034622
Provider Name (Legal Business Name): LUIS VACCARELLO M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2005
Last Update Date: 11/03/2023
Certification Date: 11/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 PLAZA PROPERTIES BLVD
COLUMBUS OH
43219-1531
US

IV. Provider business mailing address

2257 OLD STONE RD
BLACKLICK OH
43004-9558
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6000
  • Fax: 614-383-6001
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VX0201X
TaxonomyGynecologic Oncology Physician
License Number35063432
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: