Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 01043563 | IN |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35-074726 | OH |
Y | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35074726 | OH |
N | 207XX0005X | Sports Medicine Orthopaedic Surgeon | 35504 | KY |
NPI | 1174593479 |
---|---|
Provider Name | Mr. Vincent James Sammarco |
First Address | Cincinnati, OH 45247-7961 |
Second Address | Cincinnati, OH 45249 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/01/2006 |
Last Update Date | 14/07/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G76801 | (02) |