Provider Demographics
NPI:1487621090
Name:SPAGNUOLO, VINCENT (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:
Last Name:SPAGNUOLO
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 1:301 LIPPINCOTT DR STE 410
Mailing Address - Street 2:
Mailing Address - City:MARLTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08053-4197
Mailing Address - Country:US
Mailing Address - Phone:856-355-0340
Mailing Address - Fax:856-355-0330
Practice Address - Street 1:728 MARNE HWY STE 200A
Practice Address - Street 2:
Practice Address - City:MOORESTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08057-3128
Practice Address - Country:US
Practice Address - Phone:856-291-8855
Practice Address - Fax:856-291-8844
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2023-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA04573800207R00000X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1832701Medicaid
NJ124683YBAWMedicare PIN
0004090514OtherAETNA
NJD06317Medicare UPIN
060010386Medicare PIN
F01235OtherHEALTHNET
NJ1832701Medicaid