Healthcare Provider Details

I. General information

NPI: 1295027936
Provider Name (Legal Business Name): BENJAMIN JOSPEH VACCARO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/13/2011
Last Update Date: 09/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

51 N 39TH ST 4 PHI
PHILADELPHIA PA
19104
US

IV. Provider business mailing address

51 N 39TH ST 4 PHI
PHILADELPHIA PA
19104-2640
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-9190
  • Fax:
Mailing address:
  • Phone: 215-662-9190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License Number60079
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number60079
License Number StateCT
# 3
Primary TaxonomyY
Taxonomy Code207RA0001X
TaxonomyAdvanced Heart Failure and Transplant Cardiology Physician
License NumberMD467648
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: