Provider Demographics
NPI:1891814612
Name:ULLO, VINCENT
Entity Type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:
Last Name:ULLO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8618 DOE PATH LN
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-8133
Mailing Address - Country:US
Mailing Address - Phone:704-875-8473
Mailing Address - Fax:704-875-8511
Practice Address - Street 1:8618 DOE PATH LN
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-8133
Practice Address - Country:US
Practice Address - Phone:704-875-8473
Practice Address - Fax:704-875-8511
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC3408215Medicaid