Provider Demographics
NPI:1659666592
Name:CARSON, VINCENT JOSEPH (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:JOSEPH
Last Name:CARSON
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:PO BOX 500
Mailing Address - Street 2:
Mailing Address - City:INTERCOURSE
Mailing Address - State:PA
Mailing Address - Zip Code:17534
Mailing Address - Country:US
Mailing Address - Phone:717-687-9407
Mailing Address - Fax:717-687-9237
Practice Address - Street 1:20 COMMUNITY LANE
Practice Address - Street 2:
Practice Address - City:GORDONVILLE
Practice Address - State:PA
Practice Address - Zip Code:17529
Practice Address - Country:US
Practice Address - Phone:717-687-9407
Practice Address - Fax:717-687-9237
Is Sole Proprietor?:No
Enumeration Date:2011-06-17
Last Update Date:2024-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMT199560208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics