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NPI Code Detail

MEDICARE: DR. ANTHONY VACCARO M.D.

MEDICARE: DR. ANTHONY VACCARO 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
12085R0001XRadiation Oncology Physician181259-1NY

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1790786051
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANTHONY VACCARO M.D.
Provider Business Mailing Address
First Line : 2864 JOHNSON FERRY RD
Second Line : SUITE 150
City : MARIETTA
State : GA
Zip : 30062-5635
Country : US
Telephone Number : 770-693-2622
Fax Number : 770-693-6039
Provider Business Practice Location Address
First Line : 75 BEEKMAN ST
Second Line :
City : PLATTSBURGH
State : NY
Zip : 12901-1438
Country : US
Telephone Number : 518-562-7120
Fax Number : 518-562-7972
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/09/2005
Last Update Date : 08/04/2011

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