Provider Demographics
NPI:1871540880
Name:VACCARO, PATRICK S (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:S
Last Name:VACCARO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:614-293-8536
Mailing Address - Fax:614-293-8902
Practice Address - Street 1:1800 ZOLLINGER RD STE 2080
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43221-2849
Practice Address - Country:US
Practice Address - Phone:614-293-8536
Practice Address - Fax:614-293-8902
Is Sole Proprietor?:No
Enumeration Date:2006-05-27
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH350396162086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0374518Medicaid
A78392Medicare UPIN
OHVA0461518Medicare PIN