MEDICARE: DR. GREGORY JOSEPH VINCENT M.D.

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	208600000X	Surgery Physician	MD020863E	PA

General Provider Information

NPI Number	:	1083877260
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GREGORY JOSEPH VINCENT M.D.

Provider Business Mailing Address
First Line	:	4621 EDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2904
Country	:	US
Telephone Number	:	215-632-7654
Fax Number	:	215-632-7654

Provider Business Practice Location Address
First Line	:	4621 EDEN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19114-2904
Country	:	US
Telephone Number	:	215-632-7654
Fax Number	:	215-632-7654

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

Provider Enumeration Date	:	07/08/2008
Last Update Date	:	07/08/2008

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