Provider Demographics
NPI:1215022439
Name:ABAD, VINCENT TALLADA (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:TALLADA
Last Name:ABAD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:VINCENT
Other - Middle Name:TALLADA
Other - Last Name:ABAD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1515 N FEDERAL HWY STE 300
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33432-1994
Mailing Address - Country:US
Mailing Address - Phone:561-864-1076
Mailing Address - Fax:561-864-1077
Practice Address - Street 1:1650 OSCEOLA DR
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409
Practice Address - Country:US
Practice Address - Phone:561-803-8880
Practice Address - Fax:877-409-1795
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME593832084P0800X, 2084A0401X, 2084P0804X, 2084P0805X, 2084P2900X, 2084P0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction Medicine
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No2084P2900XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME59383OtherSTATE MEDICAL LICENSE NUMBER
FLBA5599999OtherDEA NUMBER