Provider Demographics
NPI:1538125299
Name:VACCARO, BERNARDINO (MD)
Entity Type:Individual
Prefix:
First Name:BERNARDINO
Middle Name:
Last Name:VACCARO
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 1:339 WASHINGTON ST STE 203
Mailing Address - Street 2:
Mailing Address - City:DEDHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02026-1870
Mailing Address - Country:US
Mailing Address - Phone:781-407-7770
Mailing Address - Fax:
Practice Address - Street 1:339 WASHINGTON ST STE 203
Practice Address - Street 2:
Practice Address - City:DEDHAM
Practice Address - State:MA
Practice Address - Zip Code:02026-1870
Practice Address - Country:US
Practice Address - Phone:781-407-7770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-21
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA770582084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry