Provider Demographics
NPI:1952372740
Name:MUSCARELLA, VINCENT A (MD)
Entity Type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:A
Last Name:MUSCARELLA
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 1:8100 CONSTITUTION PL NE
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87110-7643
Mailing Address - Country:US
Mailing Address - Phone:505-293-5333
Mailing Address - Fax:505-293-5334
Practice Address - Street 1:8100 CONSTITUTION PL NE
Practice Address - Street 2:SUITE 310
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-7643
Practice Address - Country:US
Practice Address - Phone:505-293-5333
Practice Address - Fax:505-293-5334
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM67-57207N00000X, 207ND0101X, 207ND0900X, 207NS0135X, 207NP0225X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Not Answered207NP0225XAllopathic & Osteopathic PhysiciansDermatologyPediatric Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM1997OtherBCBS
NM675700HIDEOtherPRESBYTERIAN HEALTH PLAN
NM20107Medicaid
NMD35857Medicare UPIN
NM2126281Medicare ID - Type Unspecified