Provider Demographics
NPI:1174593479
Name:SAMMARCO, VINCENT JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:VINCENT
Middle Name:JAMES
Last Name:SAMMARCO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6480 HARRISON AVE STE 201
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45247-7961
Mailing Address - Country:US
Mailing Address - Phone:513-354-3700
Mailing Address - Fax:513-354-3705
Practice Address - Street 1:8099 CORNELL RD.
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45249
Practice Address - Country:US
Practice Address - Phone:513-354-3700
Practice Address - Fax:513-354-3705
Is Sole Proprietor?:No
Enumeration Date:2006-01-26
Last Update Date:2020-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-074726207XX0005X
KY35504207XX0005X
IN01043563207XX0005X
OH35074726207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHSA0871455Medicare PIN
G76801Medicare UPIN
KY0239494Medicare PIN