Individual
DR. CLARENCE J VINCENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
952 SETON DR, CUMBERLAND, MD 21502-1950
(301) 777-3522
(301) 777-1902
Mailing address
PO BOX 808, CUMBERLAND, MD 21501-0808
(301) 724-1646
(301) 724-7429
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
D0017474
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001717208
MT ST BLUE SHIELD
WV
05
—
0086105000
—
WV
05
—
1012103550001
—
PA
05
—
411501500
—
MD
01
—
J2480005
GHMSI
MD
01
—
J2490005
GHMSI
MD
01
—
P00139754
RAILROAD MEDICARE
—
Enumeration date
05/23/2005
Last updated
07/25/2007
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