Healthcare Provider Details

I. General information

NPI: 1689767758
Provider Name (Legal Business Name): BEVERLY SURGICAL ASSOCIATES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

75 HERRICK ST SUITE 201
BEVERLY MA
01915
US

IV. Provider business mailing address

75 HERRICK ST SUITE 201
BEVERLY MA
01915
US

V. Phone/Fax

Practice location:
  • Phone: 978-927-4004
  • Fax: 978-922-6640
Mailing address:
  • Phone: 978-927-4004
  • Fax: 978-922-6640

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208C00000X
TaxonomyColon & Rectal Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: GEORGE P KACOYANIS
Title or Position: PRESIDENT
Credential: MD
Phone: 978-927-4004