Provider Demographics
NPI:1194721886
Name:GUARDIONE, VINCENT ANTHONY (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:ANTHONY
Last Name:GUARDIONE
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:PO BOX 410
Mailing Address - Street 2:
Mailing Address - City:CHICOPEE
Mailing Address - State:MA
Mailing Address - Zip Code:01021-0410
Mailing Address - Country:US
Mailing Address - Phone:413-789-8027
Mailing Address - Fax:413-789-8041
Practice Address - Street 1:401 CHESTNUT ST
Practice Address - Street 2:SUITE 1 MERCY INPATIENT MEDICAL ASSOCIATES
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01104
Practice Address - Country:US
Practice Address - Phone:413-737-3526
Practice Address - Fax:413-737-1377
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA28795208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0135828Medicaid
MA0135828Medicaid
MAA65756Medicare UPIN
P00319389Medicare PIN