Healthcare Provider Details

I. General information

NPI: 1740373737
Provider Name (Legal Business Name): GEORGE P KACOYANIS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 09/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 CUMMINGS CTR STE 1800
BEVERLY MA
01915-6141
US

IV. Provider business mailing address

35 UNITED DR STE 102
W BRIDGEWATER MA
02379-1027
US

V. Phone/Fax

Practice location:
  • Phone: 978-821-2922
  • Fax: 978-921-1534
Mailing address:
  • Phone: 508-238-8646
  • Fax: 508-230-9772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number46099
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number46099
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: