Provider Demographics
NPI:1376266239
Name:VINCENT, NORMAN ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ROBERT
Last Name:VINCENT
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 1:36133 VIREO CIR
Mailing Address - Street 2:
Mailing Address - City:OCEAN VIEW
Mailing Address - State:DE
Mailing Address - Zip Code:19970-8006
Mailing Address - Country:US
Mailing Address - Phone:302-581-2526
Mailing Address - Fax:
Practice Address - Street 1:36133 VIREO CIR
Practice Address - Street 2:
Practice Address - City:OCEAN VIEW
Practice Address - State:DE
Practice Address - Zip Code:19970-8006
Practice Address - Country:US
Practice Address - Phone:302-581-2526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-26
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT120612085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT12061OtherSTATE OF CONNECTICUT DEPARTMENT OF PUBLIC HEALTH