Provider Demographics
NPI:1710406806
Name:SCALABRINO, VINCENT FRANK JR (IDC, PARAMEDIC)
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:FRANK
Last Name:SCALABRINO
Suffix:JR
Gender:M
Credentials:IDC, PARAMEDIC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:USS THUNDERBOLT
Mailing Address - Street 2:PC 12
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09588
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:USS THUNDERBOLT
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09588
Practice Address - Country:US
Practice Address - Phone:313-485-6209
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-11
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM8033309146L00000X
1710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman
No146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
1253200231OtherTRICARE