Individual
MARY ALEXIS IACCARINO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1215 LEE ST, BOX 800793, CHARLOTTESVILLE, VA 22908-0816
(434) 924-5118
Mailing address
125 NASHUA ST, BOSTON, MA 02114-1101
(617) 573-7000
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
251264
MA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/04/2011
Last updated
01/22/2013
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