Provider Demographics
NPI:1932106846
Name:VASSALLO, JOSEPH ANTHONY (MD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:ANTHONY
Last Name:VASSALLO
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 1:5454 WISCONSIN AVE
Mailing Address - Street 2:SUITE 925
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-6901
Mailing Address - Country:US
Mailing Address - Phone:301-657-1682
Mailing Address - Fax:301-951-8036
Practice Address - Street 1:5454 WISCONSIN AVE
Practice Address - Street 2:SUITE 925
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-6901
Practice Address - Country:US
Practice Address - Phone:301-657-1682
Practice Address - Fax:301-951-8036
Is Sole Proprietor?:No
Enumeration Date:2005-07-07
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD33844207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
049626Medicare PIN
MDB92966Medicare UPIN
MD009190S12Medicare PIN