Provider Demographics
NPI:1609879295
Name:CIFELLO, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:CIFELLO
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 1:1404 CRAIN HWY S
Mailing Address - Street 2:STE 111
Mailing Address - City:GLEN BURNIE
Mailing Address - State:MD
Mailing Address - Zip Code:21061-4056
Mailing Address - Country:US
Mailing Address - Phone:410-760-9996
Mailing Address - Fax:410-582-9314
Practice Address - Street 1:1404 CRAIN HWY S
Practice Address - Street 2:STE 111
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4056
Practice Address - Country:US
Practice Address - Phone:410-760-9996
Practice Address - Fax:410-582-9314
Is Sole Proprietor?:No
Enumeration Date:2005-05-27
Last Update Date:2009-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054586208C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208C00000XAllopathic & Osteopathic PhysiciansColon & Rectal Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG94345Medicare UPIN
MD749LMedicare ID - Type Unspecified