Vincent, Gavin Blake

Vincent, Gavin Blake is an individual health care provider with primary practice located at 800 Grand Central Mall Ste 3 , Vienna WV 26105-4100. He recently has 2 registered licenses in different health care specialties including Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Vincent, Gavin Blake can be contacted via phone (304) 865-0555.

Contact Information

Primary practice address
800 Grand Central Mall Ste 3 Vienna WV 26105-4100
Phone: (304) 865-0555
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Respiratory, Developmental, Rehabilitative and Restorative Service Providers / Athletic Trainer 2255A2300X
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 2709 West Virginia

Profile Details

NPI number 1134683394
LBN Legal business name Vincent, Gavin Blake
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 22nd, 2019
Last updated May 5th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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