Provider Demographics
NPI:1003028887
Name:ANTINORE, VINCENT ROBERT
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:ROBERT
Last Name:ANTINORE
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 1:121 W JOSIE AVE
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45133-1222
Mailing Address - Country:US
Mailing Address - Phone:937-393-8399
Mailing Address - Fax:
Practice Address - Street 1:121 W JOSIE AVE
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:OH
Practice Address - Zip Code:45133-1222
Practice Address - Country:US
Practice Address - Phone:937-393-8399
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171WH0202XOther Service ProvidersContractorHome Modifications
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2558129OtherPROVIDER NUMBER