Provider Demographics
NPI:1720010531
Name:DOVICO, VINCENT (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:DOVICO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VINCENT
Other - Middle Name:
Other - Last Name:DOVICO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:4301 GENE DR
Mailing Address - Street 2:
Mailing Address - City:SEVEN HILLS
Mailing Address - State:OH
Mailing Address - Zip Code:44131-5947
Mailing Address - Country:US
Mailing Address - Phone:216-524-8228
Mailing Address - Fax:
Practice Address - Street 1:4301 GENE DR
Practice Address - Street 2:
Practice Address - City:SEVEN HILLS
Practice Address - State:OH
Practice Address - Zip Code:44131-5947
Practice Address - Country:US
Practice Address - Phone:216-524-8228
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35030614-D208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE89437Medicare UPIN