Provider Demographics
NPI:1104359314
Name:DICARLO, VICK II
Entity Type:Individual
Prefix:DR
First Name:VICK
Middle Name:
Last Name:DICARLO
Suffix:II
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 EAGLETREE LN SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-6447
Mailing Address - Country:US
Mailing Address - Phone:256-261-2826
Mailing Address - Fax:
Practice Address - Street 1:1105 EAGLETREE LN SW
Practice Address - Street 2:
Practice Address - City:HUNTSVILLE
Practice Address - State:AL
Practice Address - Zip Code:35801-6447
Practice Address - Country:US
Practice Address - Phone:256-261-2826
Practice Address - Fax:256-429-9246
Is Sole Proprietor?:No
Enumeration Date:2017-04-05
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL37659207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology