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NPI Code Detail

MEDICARE: KIMBERLY A VACCA MD

MEDICARE: KIMBERLY A VACCA MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics Physician35071486OH

General Provider Information

NPI Number : 1386740264
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY A VACCA MD
Provider Business Mailing Address
First Line : PO BOX 901874
Second Line :
City : CLEVELAND
State : OH
Zip : 44190-1874
Country : US
Telephone Number : 216-383-6480
Fax Number : 216-383-6745
Provider Business Practice Location Address
First Line : 1218 CLEVELAND RD
Second Line :
City : SANDUSKY
State : OH
Zip : 44870-4200
Country : US
Telephone Number : 216-383-0100
Fax Number : 216-383-6481
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2006
Last Update Date : 07/08/2007

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Directions to “ KIMBERLY A VACCA MD” Practice Location

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