Provider Demographics
NPI:1235358607
Name:MIRARCHI, VINCENT JOSEPH (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:JOSEPH
Last Name:MIRARCHI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4351 NW 115TH AVE
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34482-1823
Mailing Address - Country:US
Mailing Address - Phone:808-722-7934
Mailing Address - Fax:
Practice Address - Street 1:2415 SW COLLEGE RD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-1664
Practice Address - Country:US
Practice Address - Phone:352-237-3536
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-24
Last Update Date:2019-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO 309207Q00000X
HIDOS-943207Q00000X
FLOS12615207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF49185Medicare UPIN
HIH55752Medicare PIN