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NPI Code Detail

MEDICARE: MARTIN PAUL VACANTI M.D.

MEDICARE: MARTIN PAUL VACANTI 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
1207ZP0102XAnatomic Pathology & Clinical Pathology Physician155192MA

General Provider Information

NPI Number : 1740296805
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARTIN PAUL VACANTI M.D.
Provider Business Mailing Address
First Line : 600 CAISSON HILL ROAD
Second Line : IRWIN ARMY COMMUNITY HOSPITAL, ATTN: MCXX-CLD-QM CRED
City : FORT RILEY
State : KS
Zip : 66442-5037
Country : US
Telephone Number : 785-239-7155
Fax Number : 785-239-7364
Provider Business Practice Location Address
First Line : 600 CAISSON HILL ROAD
Second Line : IRWIN ARMY COMMUNITY HOSPITAL, ATTN: MCXX-CLD-QM CRED
City : FORT RILEY
State : KS
Zip : 66442-5037
Country : US
Telephone Number : 785-239-7155
Fax Number : 785-239-7364
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/31/2006
Last Update Date : 07/08/2007

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