Provider Demographics
NPI:1407388911
Name:DICARLO, VINCENT DANIEL (MD)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:DANIEL
Last Name:DICARLO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1930 BRANNAN RD
Mailing Address - Street 2:
Mailing Address - City:MCDONOUGH
Mailing Address - State:GA
Mailing Address - Zip Code:30253-4310
Mailing Address - Country:US
Mailing Address - Phone:678-284-4040
Mailing Address - Fax:678-284-4076
Practice Address - Street 1:470 NORTHSIDE CHEROKEE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:GA
Practice Address - Zip Code:30115-8029
Practice Address - Country:US
Practice Address - Phone:770-720-7246
Practice Address - Fax:770-720-4620
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-03
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA92091208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology