MEDICARE: VINCENT ANTHONY GIMINARO DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RP1001X	Pulmonary Disease Physician	H0054439	MD

General Provider Information

NPI Number	:	1730179722
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT ANTHONY GIMINARO DO

Provider Business Mailing Address
First Line	:	2012 S TOLLGATE RD
Second Line	:	STE 111
City	:	BEL AIR
State	:	MD
Zip	:	21015-5900
Country	:	US
Telephone Number	:	410-569-4144
Fax Number	:	410-569-4147

Provider Business Practice Location Address
First Line	:	2012 S TOLLGATE RD
Second Line	:	STE 111
City	:	BEL AIR
State	:	MD
Zip	:	21015-5900
Country	:	US
Telephone Number	:	410-569-4144
Fax Number	:	410-569-4147

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	01/03/2014

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