Healthcare Provider Details

I. General information

NPI: 1770561276
Provider Name (Legal Business Name): VICK S DICARLO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/04/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2010 BROOKWOOD MEDICAL CTR DR SUITE 102
BIRMINGHAM AL
35209-6804
US

IV. Provider business mailing address

2010 BROOKWOOD MEDICAL CTR DR SUITE 102
BIRMINGHAM AL
35209-6804
US

V. Phone/Fax

Practice location:
  • Phone: 205-877-5381
  • Fax: 205-877-5395
Mailing address:
  • Phone: 205-877-5381
  • Fax: 205-877-5395

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number00017174
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: