Provider Demographics
NPI:1558562769
Name:BIRBIGLIA, VINCENT PAUL (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:PAUL
Last Name:BIRBIGLIA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 EATON CT
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-2908
Mailing Address - Country:US
Mailing Address - Phone:508-420-9725
Mailing Address - Fax:
Practice Address - Street 1:6 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-3112
Practice Address - Country:US
Practice Address - Phone:508-775-2600
Practice Address - Fax:508-775-1437
Is Sole Proprietor?:No
Enumeration Date:2007-05-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34861174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0107611Medicaid
MAN01578Medicare ID - Type Unspecified
MA0107611Medicaid