Provider Demographics
NPI:1407240765
Name:VINSANT, VICTORIA NICOLE (MD)
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:NICOLE
Last Name:VINSANT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:839 OAK ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43205-1142
Mailing Address - Country:US
Mailing Address - Phone:513-646-9756
Mailing Address - Fax:
Practice Address - Street 1:1021 COUNTRY CLUB RD UNIT A
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43213
Practice Address - Country:US
Practice Address - Phone:614-501-7337
Practice Address - Fax:614-434-2701
Is Sole Proprietor?:No
Enumeration Date:2015-03-25
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH1407240765208000000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program