Provider Demographics
NPI:1184688269
Name:VINCENT, JOHN MICHAEL (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MICHAEL
Last Name:VINCENT
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Gender:M
Credentials:MD
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Mailing Address - Street 1:230 SCHILLING CIR
Mailing Address - Street 2:STE 170
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1417
Mailing Address - Country:US
Mailing Address - Phone:410-296-4616
Mailing Address - Fax:410-337-5068
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:SUITE 4226
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-2202
Practice Address - Fax:410-337-5068
Is Sole Proprietor?:No
Enumeration Date:2006-04-14
Last Update Date:2019-10-22
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Provider Licenses
StateLicense IDTaxonomies
MDD0036776207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD284361700Medicaid
MDD72271Medicare UPIN
MD284361700Medicaid