Provider Demographics
NPI:1235103458
Name:IACONO, VINCENT R (MD)
Entity type:Individual
Prefix:DR
First Name:VINCENT
Middle Name:R
Last Name:IACONO
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 1:560 TOLL GATE RD
Mailing Address - Street 2:
Mailing Address - City:WARWICK
Mailing Address - State:RI
Mailing Address - Zip Code:02886-2716
Mailing Address - Country:US
Mailing Address - Phone:401-738-8610
Mailing Address - Fax:401-732-6629
Practice Address - Street 1:560 TOLL GATE RD
Practice Address - Street 2:
Practice Address - City:WARWICK
Practice Address - State:RI
Practice Address - Zip Code:02886-2716
Practice Address - Country:US
Practice Address - Phone:401-738-8610
Practice Address - Fax:401-732-6629
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI004352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI001081OtherBLUE CHIP
RI786-7OtherBLUE CROSS OF RHODE ISLAN
RI786-7OtherBLUE CROSS OF RHODE ISLAN