Provider Demographics
NPI:1194727933
Name:VACCARIELLO, JOHN A (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:A
Last Name:VACCARIELLO
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 1:151 PARKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MILLERSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:44654-8949
Mailing Address - Country:US
Mailing Address - Phone:330-674-1200
Mailing Address - Fax:330-674-3320
Practice Address - Street 1:151 PARKVIEW DR
Practice Address - Street 2:
Practice Address - City:MILLERSBURG
Practice Address - State:OH
Practice Address - Zip Code:44654-8949
Practice Address - Country:US
Practice Address - Phone:330-674-1200
Practice Address - Fax:330-674-3320
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-06-7326-V207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2016642Medicaid
OH341774347OtherTAX ID
OH341774347OtherTAX ID
OHG47551Medicare UPIN