Provider Demographics
NPI:1396228474
Name:HOUSTON, VINCENT EDWARD
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:EDWARD
Last Name:HOUSTON
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 1:10 CASTLE HAVEN RD
Mailing Address - Street 2:
Mailing Address - City:HAMPTON
Mailing Address - State:VA
Mailing Address - Zip Code:23666-6032
Mailing Address - Country:US
Mailing Address - Phone:757-272-7524
Mailing Address - Fax:
Practice Address - Street 1:10 CASTLE HAVEN RD
Practice Address - Street 2:
Practice Address - City:HAMPTON
Practice Address - State:VA
Practice Address - Zip Code:23666-6032
Practice Address - Country:US
Practice Address - Phone:757-272-7524
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-13
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747A0650XNursing Service Related ProvidersTechnicianAttendant Care Provider