Provider Demographics
NPI:1073502308
Name:SACCO, VINCENT GERALD (DO)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:GERALD
Last Name:SACCO
Suffix:
Gender:M
Credentials:DO
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Other - Credentials:
Mailing Address - Street 1:2701 HOLME AVE
Mailing Address - Street 2:STE 202
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19152-2029
Mailing Address - Country:US
Mailing Address - Phone:215-333-9901
Mailing Address - Fax:215-333-9828
Practice Address - Street 1:2701 HOLME AVE
Practice Address - Street 2:STE 202
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152-2029
Practice Address - Country:US
Practice Address - Phone:215-333-9901
Practice Address - Fax:215-333-9828
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2014-01-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOS007248L207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
0522649000OtherKEYSTONE
D798077001OtherAMERIHEALTH
2298615OtherAETNA
2298615OtherAETNA
E99212Medicare UPIN