Provider Demographics
NPI:1144286816
Name:VINCENT, ALICE C (MD PHD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:C
Last Name:VINCENT
Suffix:
Gender:F
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 BOYLSTON ST
Mailing Address - Street 2:
Mailing Address - City:CHESTNUT HILL
Mailing Address - State:MA
Mailing Address - Zip Code:02467-2477
Mailing Address - Country:US
Mailing Address - Phone:617-732-9823
Mailing Address - Fax:617-566-2224
Practice Address - Street 1:850 BOYLSTON ST
Practice Address - Street 2:
Practice Address - City:CHESTNUT HILL
Practice Address - State:MA
Practice Address - Zip Code:02467-2477
Practice Address - Country:US
Practice Address - Phone:617-732-9823
Practice Address - Fax:617-566-2224
Is Sole Proprietor?:No
Enumeration Date:2006-04-21
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA205374207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0191132Medicaid
MA0191132Medicaid
MANX1080Medicare PIN
MAA33156Medicare PIN