Provider Demographics
NPI:1932148798
Name:VACCARO, ALEXANDER RICHARD (MD, PHD)
Entity Type:Individual
Prefix:
First Name:ALEXANDER
Middle Name:RICHARD
Last Name:VACCARO
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:833 CHESTNUT ST STE 520
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107-4430
Mailing Address - Country:US
Mailing Address - Phone:800-321-9999
Mailing Address - Fax:267-479-1321
Practice Address - Street 1:925 CHESTNUT ST
Practice Address - Street 2:5TH FLOOR
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107-4216
Practice Address - Country:US
Practice Address - Phone:267-339-3500
Practice Address - Fax:215-503-0580
Is Sole Proprietor?:No
Enumeration Date:2006-06-06
Last Update Date:2022-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA06332600207XS0117X
DEC1-0006845207XS0117X
HIMD-13007207XS0117X
CAG73115207XS0117X
FLME152589207XS0117X
NY290677-1207XS0117X
PAMD042291E207XS0117X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the Spine
Provider Identifiers
StateIdentifier IDID TypeIssuer
4181347OtherCIGNA
PA0466660OtherAETNA
PA0656057000OtherIBC
NJ0363251000OtherIBC
NJ2378258OtherAETNA
PA0466660OtherAETNA
NJ2378258OtherAETNA
NJ200043291Medicare PIN
PA200025424Medicare PIN
PA746695GC6Medicare ID - Type Unspecified