Healthcare Provider Details

I. General information

NPI: 1770427213
Provider Name (Legal Business Name): VINCENT ALLEN MCGREAL II
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/15/2026
Last Update Date: 04/19/2026
Certification Date: 04/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11750 KLINGER AVE NE
ALLIANCE OH
44601-1113
US

IV. Provider business mailing address

414 FAIRCHILD AVE APT 2
KENT OH
44240-2126
US

V. Phone/Fax

Practice location:
  • Phone: 330-823-8263
  • Fax:
Mailing address:
  • Phone: 234-201-5183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: