Provider Demographics
NPI:1497731038
Name:VINCENT, CAROLE ANN (DO)
Entity Type:Individual
Prefix:
First Name:CAROLE
Middle Name:ANN
Last Name:VINCENT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N ACADEMY AVE
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:17822-9800
Mailing Address - Country:US
Mailing Address - Phone:570-271-6144
Mailing Address - Fax:
Practice Address - Street 1:1165 CENTRE TPKE
Practice Address - Street 2:
Practice Address - City:ORWIGSBURG
Practice Address - State:PA
Practice Address - Zip Code:17961-9343
Practice Address - Country:US
Practice Address - Phone:570-968-1300
Practice Address - Fax:570-968-1305
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS011914208600000X
NJ25MB06398300208600000X
RIDO00838208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7842007Medicaid
MN570032900Medicaid
MN570032900Medicaid
NJ235409C04Medicare PIN
MN570032900Medicaid
G80968Medicare UPIN
MN020002123Medicare ID - Type Unspecified