MEDICARE: DR. VINCENT A. IANNACE MD

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	208600000X	Surgery Physician	2016-02099	NC

General Provider Information

NPI Number	:	1952366171
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT A. IANNACE MD

Provider Business Mailing Address
First Line	:	781 AVENT FERRY RD STE 214
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7776
Country	:	US
Telephone Number	:	919-578-4787
Fax Number	:

Provider Business Practice Location Address
First Line	:	781 AVENT FERRY RD STE 214
Second Line	:
City	:	HOLLY SPRINGS
State	:	NC
Zip	:	27540-7776
Country	:	US
Telephone Number	:	919-784-7874
Fax Number	:	919-784-2708

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

Provider Enumeration Date	:	04/19/2006
Last Update Date	:	07/09/2021

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