Provider Demographics
NPI:1407832595
Name:VACCA, VINCENT FIORE (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:FIORE
Last Name:VACCA
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:PO BOX 2153 DEPT 40338
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35287-9386
Mailing Address - Country:US
Mailing Address - Phone:423-310-1642
Mailing Address - Fax:
Practice Address - Street 1:1524 ATWOOD AVE
Practice Address - Street 2:
Practice Address - City:JOHNSTON
Practice Address - State:RI
Practice Address - Zip Code:02919-3228
Practice Address - Country:US
Practice Address - Phone:401-383-0400
Practice Address - Fax:401-383-0410
Is Sole Proprietor?:No
Enumeration Date:2005-12-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD03694207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C90321Medicare UPIN
RI007056076Medicare PIN