Provider Demographics
NPI:1194109686
Name:INCAREMD
Entity type:Organization
Organization Name:INCAREMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VINSON
Authorized Official - Middle Name:M
Authorized Official - Last Name:DISANTO
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:866-397-2104
Mailing Address - Street 1:1325 SATELLITE BLVD NW
Mailing Address - Street 2:
Mailing Address - City:SUWANEE
Mailing Address - State:GA
Mailing Address - Zip Code:30024-4651
Mailing Address - Country:US
Mailing Address - Phone:866-397-2104
Mailing Address - Fax:
Practice Address - Street 1:1325 SATELLITE BLVD NW
Practice Address - Street 2:
Practice Address - City:SUWANEE
Practice Address - State:GA
Practice Address - Zip Code:30024-4651
Practice Address - Country:US
Practice Address - Phone:866-397-2104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-14
Last Update Date:2015-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty