Provider Demographics
NPI:1568580306
Name:VINCENT, DOROTHY VAUGHN (MD)
Entity Type:Individual
Prefix:
First Name:DOROTHY
Middle Name:VAUGHN
Last Name:VINCENT
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 1:1429 E MARION ST
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SHELBY
Mailing Address - State:NC
Mailing Address - Zip Code:28150-4986
Mailing Address - Country:US
Mailing Address - Phone:704-480-5440
Mailing Address - Fax:704-480-5477
Practice Address - Street 1:1429 E MARION ST
Practice Address - Street 2:SUITE 5
Practice Address - City:SHELBY
Practice Address - State:NC
Practice Address - Zip Code:28150-4986
Practice Address - Country:US
Practice Address - Phone:704-480-5440
Practice Address - Fax:704-480-5477
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC128N5OtherBCBS
NC89128N5Medicaid
NCA99316Medicare UPIN