Provider Demographics
NPI:1780995787
Name:ACKERMAN, VINCENT L (DO)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:L
Last Name:ACKERMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 810 BOX 247
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09589-0003
Mailing Address - Country:US
Mailing Address - Phone:240-245-4659
Mailing Address - Fax:
Practice Address - Street 1:PSC 810
Practice Address - Street 2:NMRTC GB
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09589-0003
Practice Address - Country:US
Practice Address - Phone:240-245-4659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE0845207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine