MEDICARE: DR. VINCENT DEGENNARO JR. MD, MPH

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	207R00000X	Internal Medicine Physician	255868	NY
2	207R00000X	Internal Medicine Physician	ME115181	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821258419
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. VINCENT DEGENNARO JR. MD, MPH

Provider Business Mailing Address
First Line	:	6255 W SUNSET BLVD FL 21
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90028-7422
Country	:	US
Telephone Number	:	323-860-5200
Fax Number	:

Provider Business Practice Location Address
First Line	:	6333 N FEDERAL HWY STE 301302
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1907
Country	:	US
Telephone Number	:	954-772-2411
Fax Number	:

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

Provider Enumeration Date	:	06/17/2008
Last Update Date	:	06/27/2025

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