Provider Demographics
NPI:1588860373
Name:MCGINNISS, VINCENT CHARLES (DO)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:CHARLES
Last Name:MCGINNISS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1526 DONEGAL DR
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-6058
Mailing Address - Country:US
Mailing Address - Phone:614-579-1886
Mailing Address - Fax:
Practice Address - Street 1:707 W EAU GALLIE BLVD
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32935-5958
Practice Address - Country:US
Practice Address - Phone:321-727-3223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-27
Last Update Date:2016-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101017352207YS0123X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0123XAllopathic & Osteopathic PhysiciansOtolaryngologyFacial Plastic Surgery