Provider Demographics
NPI:1558448662
Name:ENGEL, VINCENT EMERSON
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:EMERSON
Last Name:ENGEL
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:VINCE
Other - Middle Name:
Other - Last Name:ENGEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:136 SHEPARDSON CT
Mailing Address - Street 2:
Mailing Address - City:GRANVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43023-1155
Mailing Address - Country:US
Mailing Address - Phone:740-504-5443
Mailing Address - Fax:
Practice Address - Street 1:136 SHEPARDSON CT
Practice Address - Street 2:
Practice Address - City:GRANVILLE
Practice Address - State:OH
Practice Address - Zip Code:43023-1155
Practice Address - Country:US
Practice Address - Phone:740-504-5443
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH125363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant