Provider Demographics
NPI:1730179722
Name:GIMINARO, VINCENT ANTHONY (DO)
Entity type:Individual
Prefix:
First Name:VINCENT
Middle Name:ANTHONY
Last Name:GIMINARO
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2012 S TOLLGATE RD
Mailing Address - Street 2:STE 111
Mailing Address - City:BEL AIR
Mailing Address - State:MD
Mailing Address - Zip Code:21015-5900
Mailing Address - Country:US
Mailing Address - Phone:410-569-4144
Mailing Address - Fax:410-569-4147
Practice Address - Street 1:2012 S TOLLGATE RD
Practice Address - Street 2:STE 111
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-5900
Practice Address - Country:US
Practice Address - Phone:410-569-4144
Practice Address - Fax:410-569-4147
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDH0054439207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD688MMedicare PIN