Provider Demographics
NPI:1053639054
Name:VINCENT, SAMANTHA FAYE (MD)
Entity Type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:FAYE
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:SAMANTHA
Other - Middle Name:FAYE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1447 YORK RD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-6017
Mailing Address - Country:US
Mailing Address - Phone:410-252-9090
Mailing Address - Fax:410-494-7064
Practice Address - Street 1:1447 YORK RD
Practice Address - Street 2:SUITE 301
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-6017
Practice Address - Country:US
Practice Address - Phone:410-252-9090
Practice Address - Fax:410-494-7064
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-14
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0079140207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology