Provider Demographics
NPI:1912181363
Name:H MARCELO VASSOLO MD PA
Entity Type:Organization
Organization Name:H MARCELO VASSOLO MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:H MARCELO
Authorized Official - Middle Name:
Authorized Official - Last Name:VASSOLO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:786-753-5898
Mailing Address - Street 1:21097 NE 27TH CT
Mailing Address - Street 2:SUITE 400
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180-1204
Mailing Address - Country:US
Mailing Address - Phone:786-621-3897
Mailing Address - Fax:786-975-2643
Practice Address - Street 1:2801 NE 213TH ST STE 1015
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180-1266
Practice Address - Country:US
Practice Address - Phone:786-753-5898
Practice Address - Fax:786-756-0205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-20
Last Update Date:2021-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty