Healthcare Provider Details

I. General information

NPI: 1992463194
Provider Name (Legal Business Name): VINCENT QUOC VUONG PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/04/2021
Last Update Date: 01/18/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 CHERRY TREE CT
FOREST HILL MD
21050-3072
US

IV. Provider business mailing address

310 CHERRY TREE CT
FOREST HILL MD
21050-3072
US

V. Phone/Fax

Practice location:
  • Phone: 443-910-6763
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberC0008304
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: