Healthcare Provider Details

I. General information

NPI: 1407832595
Provider Name (Legal Business Name): VINCENT FIORE VACCA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2005
Last Update Date: 08/20/2020
Certification Date: 08/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1524 ATWOOD AVE
JOHNSTON RI
02919-3228
US

IV. Provider business mailing address

PO BOX 2153 DEPT 40338
BIRMINGHAM AL
35287-9386
US

V. Phone/Fax

Practice location:
  • Phone: 401-383-0400
  • Fax: 401-383-0410
Mailing address:
  • Phone: 423-310-1642
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberMD03694
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: