Provider Demographics
NPI:1255866851
Name:VASCONCELOS, MARCIO (MD)
Entity Type:Individual
Prefix:
First Name:MARCIO
Middle Name:
Last Name:VASCONCELOS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:AVENIDA DAS AMERICAS, 700
Mailing Address - Street 2:SL. 229 BL. 06
Mailing Address - City:RIO DE JANEIRO
Mailing Address - State:RJ
Mailing Address - Zip Code:22640100
Mailing Address - Country:BR
Mailing Address - Phone:55212-132-8080
Mailing Address - Fax:55212-132-8080
Practice Address - Street 1:AVENIDA DAS AMERICAS, 700
Practice Address - Street 2:SL. 229 BL. 06
Practice Address - City:RIO DE JANEIRO
Practice Address - State:RJ
Practice Address - Zip Code:22640100
Practice Address - Country:BR
Practice Address - Phone:55212-132-8080
Practice Address - Fax:55212-132-8080
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101055379208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics