Provider Demographics
NPI:1235709148
Name:VINCENT, NANA T
Entity Type:Individual
Prefix:
First Name:NANA
Middle Name:T
Last Name:VINCENT
Suffix:
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:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20703-0122
Mailing Address - Country:US
Mailing Address - Phone:240-424-9615
Mailing Address - Fax:
Practice Address - Street 1:9821 GREENBELT RD
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2265
Practice Address - Country:US
Practice Address - Phone:240-424-9615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-01
Last Update Date:2022-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDN0001741207U00000X, 3336N0007X, 207UN0902X, 207UN0903X, 2085N0904X, 2471N0900X, 207UN0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207UN0901XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Cardiology
No207U00000XAllopathic & Osteopathic PhysiciansNuclear Medicine
No3336N0007XSuppliersPharmacyNuclear Pharmacy
No207UN0902XAllopathic & Osteopathic PhysiciansNuclear MedicineNuclear Imaging & Therapy
No207UN0903XAllopathic & Osteopathic PhysiciansNuclear MedicineIn Vivo & In Vitro Nuclear Medicine
No2085N0904XAllopathic & Osteopathic PhysiciansRadiologyNuclear Radiology
No2471N0900XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistNuclear Medicine Technology