Healthcare Provider Details

I. General information

NPI: 1932154820
Provider Name (Legal Business Name): MARTIN C VINCENT MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2006
Last Update Date: 07/02/2025
Certification Date: 07/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0001
US

IV. Provider business mailing address

3700 WASHINGTON AVE
EVANSVILLE IN
47714-0001
US

V. Phone/Fax

Practice location:
  • Phone: 812-485-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2080N0001X
TaxonomyNeonatal-Perinatal Medicine Physician
License Number01053172A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: