Active NPI
Clarence J Vincent, M.D.
- Specialist
- Cumberland, MD
National Provider Identifier
1457354516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Specialist
- License
- D0017474
- Practice address
- 952 Seton Dr
Cumberland, MD 21502-1950 - Phone
- (301) 777-3522
- Fax
- (301) 777-1902
- NPI assigned
- May 23, 2005
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | D0017474 | MD | Primary |
Addresses
Primary practice location
952 Seton Dr
Cumberland, MD 21502-1950
Mailing address
PO Box 808
Cumberland, MD 21501-0808
Phone (301) 724-1646
Other identifiers 7
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 001717208 | Other | WV | MT ST BLUE SHIELD |
| J2490005 | Other | MD | GHMSI |
| 1012103550001 | Medicaid | PA | |
| 0086105000 | Medicaid | WV | |
| 411501500 | Medicaid | MD | |
| J2480005 | Other | MD | GHMSI |
| P00139754 | Other | RAILROAD MEDICARE |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| D0017474 | MD | MD | Specialist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1116806400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1185321600000",
"number": "1457354516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 808",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215010808",
"telephone_number": "301-724-1646",
"fax_number": "301-724-7429"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "952 SETON DR",
"city": "CUMBERLAND",
"state": "MD",
"postal_code": "215021950",
"telephone_number": "301-777-3522",
"fax_number": "301-777-1902"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VINCENT",
"first_name": "CLARENCE",
"middle_name": "J",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2005-05-23",
"last_updated": "2007-07-25",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "MD",
"license": "D0017474",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MT ST BLUE SHIELD",
"identifier": "001717208",
"state": "WV"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHMSI",
"identifier": "J2490005",
"state": "MD"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1012103550001",
"state": "PA"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "0086105000",
"state": "WV"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "411501500",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "GHMSI",
"identifier": "J2480005",
"state": "MD"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "P00139754",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Cumberland, MD
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.