MEDICARE: DR. DEBRA A VACHON M.D.

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
1	208C00000X	Colon & Rectal Surgery Physician	D0033732	MD

General Provider Information

NPI Number	:	1710980305
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DEBRA A VACHON M.D.

Provider Business Mailing Address
First Line	:	301 SAINT PAUL PL
Second Line	:	STE 400
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2102
Country	:	US
Telephone Number	:	410-783-5800
Fax Number	:	410-783-5855

Provider Business Practice Location Address
First Line	:	301 SAINT PAUL PL
Second Line	:	STE 400
City	:	BALTIMORE
State	:	MD
Zip	:	21202-2102
Country	:	US
Telephone Number	:	410-783-5800
Fax Number	:	410-783-5855

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2005
Last Update Date	:	12/16/2009

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