Provider Demographics
NPI:1780676775
Name:WROBLEWSKI, VINCENT PAUL (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:PAUL
Last Name:WROBLEWSKI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1623 BELLONA AVE
Mailing Address - Street 2:
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5529
Mailing Address - Country:US
Mailing Address - Phone:410-252-4406
Mailing Address - Fax:410-252-5655
Practice Address - Street 1:1623 BELLONA AVE
Practice Address - Street 2:
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5529
Practice Address - Country:US
Practice Address - Phone:410-252-4406
Practice Address - Fax:410-252-5655
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD043031207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F30876Medicare UPIN
MDO25RMedicare PIN