Individual
PROF. MICHAEL C VACCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1980 HOLTON AVE E, SUITE 203, BIG STONE GAP, VA 24219-3366
(276) 523-8681
(276) 523-8684
Mailing address
999 EXECUTIVE PARK BLVD, SUITE 201, KINGSPORT, TN 37660-4632
(423) 224-3250
(423) 224-3258
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
0101237952
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
010157617
—
VA
05
—
64103930
—
KY
Enumeration date
02/07/2006
Last updated
07/27/2012
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