Provider Demographics
NPI:1801830260
Name:HADDAD, VINCENT T (PA-C)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:T
Last Name:HADDAD
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1932 ALCOA HWY BLDG C
Mailing Address - Street 2:SUITE 255
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37920-1527
Mailing Address - Country:US
Mailing Address - Phone:865-524-7869
Mailing Address - Fax:865-544-6533
Practice Address - Street 1:1932 ALCOA HWY BLDG C
Practice Address - Street 2:SUITE 255
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37920-1527
Practice Address - Country:US
Practice Address - Phone:865-524-7869
Practice Address - Fax:865-544-6533
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2009-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA2726363AM0700X, 363AS0400X
TN1736363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE1380UMedicare ID - Type Unspecified
FLS65554Medicare UPIN