Provider Demographics
NPI:1548528441
Name:DEGUZMAN, VICENTE CARREON (MD)
Entity type:Individual
Prefix:DR
First Name:VICENTE
Middle Name:CARREON
Last Name:DEGUZMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICENTE
Other - Middle Name:CARREON
Other - Last Name:DEGUZMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:11219 POTOMAC CREST DR
Mailing Address - Street 2:
Mailing Address - City:POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20854-2743
Mailing Address - Country:US
Mailing Address - Phone:301-299-6071
Mailing Address - Fax:
Practice Address - Street 1:11219 POTOMAC CREST DR
Practice Address - Street 2:
Practice Address - City:POTOMAC
Practice Address - State:MD
Practice Address - Zip Code:20854-2743
Practice Address - Country:US
Practice Address - Phone:301-299-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-27
Last Update Date:2012-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0003025174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist