Healthcare Provider Details

I. General information

NPI: 1366417727
Provider Name (Legal Business Name): JOSEPH E VACCARELLA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/21/2006
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1419 CEDAR RD SUITE 101
CHESAPEAKE VA
23322-7492
US

IV. Provider business mailing address

PO BOX 7068
PORTSMOUTH VA
23707-0068
US

V. Phone/Fax

Practice location:
  • Phone: 757-842-6180
  • Fax: 757-842-6181
Mailing address:
  • Phone: 757-686-3516
  • Fax: 757-686-0541

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0101049827
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: