Provider Demographics
NPI:1770561276
Name:DICARLO, VICK S (MD)
Entity type:Individual
Prefix:
First Name:VICK
Middle Name:S
Last Name:DICARLO
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35209-6804
Mailing Address - Country:US
Mailing Address - Phone:205-877-5381
Mailing Address - Fax:205-877-5395
Practice Address - Street 1:2010 BROOKWOOD MEDICAL CTR DR
Practice Address - Street 2:SUITE 102
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35209-6804
Practice Address - Country:US
Practice Address - Phone:205-877-5381
Practice Address - Fax:205-877-5395
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
AL000171742080N0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
F54319Medicare UPIN