Provider Demographics
NPI:1285613448
Name:VACCARO, CARLA MARIE (MD)
Entity type:Individual
Prefix:
First Name:CARLA
Middle Name:MARIE
Last Name: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 1:4 RANGER CT
Mailing Address - Street 2:
Mailing Address - City:JAMESTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02835-1837
Mailing Address - Country:US
Mailing Address - Phone:401-423-2616
Mailing Address - Fax:401-423-3485
Practice Address - Street 1:20 SOUTHWEST AVE
Practice Address - Street 2:
Practice Address - City:JAMESTOWN
Practice Address - State:RI
Practice Address - Zip Code:02835-1120
Practice Address - Country:US
Practice Address - Phone:401-423-2616
Practice Address - Fax:401-423-3485
Is Sole Proprietor?:No
Enumeration Date:2006-01-15
Last Update Date:2012-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD10354207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0171565Medicaid
MAH20267Medicare UPIN
MA0171565Medicaid