MEDICARE: MRS. DEBRA ANNE VINCENT MA ,RDN,CDOE,CVDOE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	133V00000X	Registered Dietitian	676708	RI
2	133V00000X	Registered Dietitian	LDN00057	RI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	403156	OTHER	RI	BLUE CHIP
2	256106	OTHER	RI	RI BLUE CROSS

General Provider Information

NPI Number	:	1053485185
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DEBRA ANNE VINCENT MA ,RDN,CDOE,CVDOE

Provider Business Mailing Address
First Line	:	100 TWIN BIRCH DR
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02921-7512
Country	:	US
Telephone Number	:	401-426-0018
Fax Number	:	401-944-1812

Provider Business Practice Location Address
First Line	:	63 SOCKANOSSET CROSS RD
Second Line	:	SUITE A
City	:	CRANSTON
State	:	RI
Zip	:	02920-5557
Country	:	US
Telephone Number	:	401-426-0018
Fax Number	:	401-944-1812

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	10/15/2016

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