Healthcare Provider Details

I. General information

NPI: 1750561429
Provider Name (Legal Business Name): ALEXANDRA RUTH VACCARO PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 05/30/2024
Certification Date: 05/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S JACKSON AVE
PITTSBURGH PA
15202-3428
US

IV. Provider business mailing address

100 S JACKSON AVE
PITTSBURGH PA
15202-3428
US

V. Phone/Fax

Practice location:
  • Phone: 412-734-6100
  • Fax: 412-734-6800
Mailing address:
  • Phone: 412-734-6100
  • Fax: 412-734-6800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberMA053192
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: