Provider Demographics
NPI:1285683219
Name:LUBRANO, VINCENT M (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:M
Last Name:LUBRANO
Suffix:
Gender:M
Credentials:MD
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 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-331-4665
Mailing Address - Fax:859-331-6370
Practice Address - Street 1:20 MEDICAL VILLAGE DRIVE
Practice Address - Street 2:SUITE 354
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-331-4665
Practice Address - Fax:859-331-6370
Is Sole Proprietor?:No
Enumeration Date:2006-05-08
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY27258207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64272586Medicaid
KY1042202Medicare PIN
E02494Medicare UPIN