Provider Demographics
NPI:1487860193
Name:UROLOGICAL CONSULTANTS
Entity Type:Organization
Organization Name:UROLOGICAL CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:A
Authorized Official - Last Name:VACCARO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-572-6835
Mailing Address - Street 1:1901 S UNION AVE
Mailing Address - Street 2:#A221
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405
Mailing Address - Country:US
Mailing Address - Phone:253-572-6835
Mailing Address - Fax:253-573-9238
Practice Address - Street 1:1901 S UNION AVE
Practice Address - Street 2:#A221
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405
Practice Address - Country:US
Practice Address - Phone:253-572-6835
Practice Address - Fax:253-573-9238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00036292208600000X
WAMD00028510208800000X
WA208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Not Answered208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F75061Medicare UPIN
E84400Medicare UPIN