Provider Demographics
NPI:1013157858
Name:SIRACUSANO, VINCENT CHARLES (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:CHARLES
Last Name:SIRACUSANO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 W MARKET ST
Mailing Address - Street 2:PENINSULA MENTAL HEALTH SERVICES
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21801-4933
Mailing Address - Country:US
Mailing Address - Phone:410-860-2673
Mailing Address - Fax:410-860-0450
Practice Address - Street 1:102 W MARKET ST
Practice Address - Street 2:PENINSULA MENTAL HEALTH SERVICES
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21801-4933
Practice Address - Country:US
Practice Address - Phone:410-860-2673
Practice Address - Fax:410-860-0450
Is Sole Proprietor?:No
Enumeration Date:2009-03-05
Last Update Date:2009-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD00395472084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry