Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207P00000X | Emergency Physician | 288929 | NY |
N | 207P00000X | Emergency Physician | MT206727 | PA |
NPI | 1003220864 |
---|---|
Provider Name | Alexander Vazzano |
First Address | Philadelphia, PA 19102-1101 |
Second Address | Rochester, NY 14621-3001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/06/2014 |
Last Update Date | 24/07/2017 |