Provider Demographics
NPI:1912092115
Name:VACCARI, CHRISTOPHER SEVERINO (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:SEVERINO
Last Name:VACCARI
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 1:1733 HOWELL RD
Mailing Address - Street 2:
Mailing Address - City:HAGERSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21740-6638
Mailing Address - Country:US
Mailing Address - Phone:301-797-2525
Mailing Address - Fax:301-797-6394
Practice Address - Street 1:1733 HOWELL RD
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-6638
Practice Address - Country:US
Practice Address - Phone:301-797-2525
Practice Address - Fax:301-797-6394
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA054288207R00000X
VA0101269224207RC0000X
MDD0067246207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
133989ZA4SMedicare PIN