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Individual

CHRISTOPHER KELLY VINCENT

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D. PH.D.

Contact information

Practice address
510 BUTLER AVE, DEPARTMENT OF SURGERY, MARTINSBURG, WV 25405-9990
(304) 263-0811
Mailing address
510 BUTLER AVE, DEPARTMENT OF SURGERY, MARTINSBURG, WV 25405-9990
(304) 263-0811

Taxonomy

Speciality
Code
Description
License number
State
2086S0129X
Vascular Surgery Physician
Primary
0101238773
VA
208G00000X
Thoracic Surgery (Cardiothoracic Vascular Surgery) Physician
0101238773
VA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
010405670
VA
01
P00453908
MEDICARE RAILROAD
VA
Enumeration date
01/04/2007
Last updated
04/22/2016
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