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Individual

DR. ANTHONY C VACCA

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
1101 JACKSON ST STE A, GREENVILLE, OH 45331-1396
(375) 472-2129
(937) 547-3066
Mailing address
1100 REID PARKWAY, MEDICAL STAFF SERVICES, RICHMOND, IN 47374
(765) 935-8802
(765) 983-3219

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
036105971
IL
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
036105971
IL
207RP1001X
Pulmonary Disease Physician
02004966A
IN
207RP1001X
Pulmonary Disease Physician
036105971
IL
207RP1001X
Pulmonary Disease Physician
Primary
34.005077
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
036105971
IL
01
04132005
BCBS
IL
01
081851
HEALTH ALLIANCE
IL
01
264630
HEALTHLINK
IL
01
290014938
MEDICARE RAILROAD
IL
05
300046415
IN
Enumeration date
06/12/2006
Last updated
01/11/2022
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