Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | D0079140 | MD |
NPI | 1053639054 |
---|---|
Provider Name | Samantha Faye Vincent |
First Address | Lutherville, MD 21093-6017 |
Second Address | Lutherville, MD 21093-6017 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/05/2010 |
Last Update Date | 29/01/2016 |