Healthcare Provider Details

I. General information

NPI: 1376587576
Provider Name (Legal Business Name): VINCENT G LOBO DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2006
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 SHAW AVE
HARRINGTON DE
19952-1220
US

IV. Provider business mailing address

PO BOX 1036
BETHANY BEACH DE
19930-1036
US

V. Phone/Fax

Practice location:
  • Phone: 302-398-8704
  • Fax: 302-398-8818
Mailing address:
  • Phone: 302-242-6352
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberC2-0000334
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: