Provider Demographics
NPI:1184737389
Name:ASTILL-VACCARO, JOANNE (MD)
Entity type:Individual
Prefix:
First Name:JOANNE
Middle Name:
Last Name:ASTILL-VACCARO
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 LIGHTHOUSE RD
Mailing Address - Street 2:
Mailing Address - City:PLATTSBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12901-7020
Mailing Address - Country:US
Mailing Address - Phone:518-569-0587
Mailing Address - Fax:518-563-3016
Practice Address - Street 1:75 BEEKMAN ST
Practice Address - Street 2:
Practice Address - City:PLATTSBURGH
Practice Address - State:NY
Practice Address - Zip Code:12901-1438
Practice Address - Country:US
Practice Address - Phone:518-562-7120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1857172084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01223138Medicaid
NYE68747Medicare UPIN
NY01223138Medicaid
NY55417GMedicare ID - Type UnspecifiedMEDICARE NUMBER