Provider Demographics
NPI:1700994209
Name:VINCENT, MICHAEL (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:VINCENT
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 1:1711 WOODLAWN AVE
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-2455
Mailing Address - Country:US
Mailing Address - Phone:302-656-3319
Mailing Address - Fax:
Practice Address - Street 1:1711 WOODLAWN AVE
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19806-2455
Practice Address - Country:US
Practice Address - Phone:302-656-3319
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10002069207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE26320OtherCOVENTRY
DE2042344OtherAETNA
514OtherMID-ATLANTIC HEALTH SYSTE
0081114000OtherAMERIHEALTH HMO
DE119833Medicare ID - Type Unspecified
DE26320OtherCOVENTRY