Individual
DR. MARK VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
19485 OLD JETTON RD, SUITE 100, CORNELIUS, NC 28031-6582
(704) 384-1775
Mailing address
PO BOX 602362, CHARLOTTE, NC 28260-2362
(704) 316-4979
(704) 316-4978
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
39542
SC
207Q00000X
Family Medicine Physician
Primary
95-01448
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8985059
—
NC
Enumeration date
05/08/2007
Last updated
04/08/2019
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