Healthcare Provider Details

I. General information

NPI: 1932622131
Provider Name (Legal Business Name): GEORGE P KACOYANIS MD FACS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2017
Last Update Date: 01/21/2019
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

VIII. Authorized Official

Name: GEORGE P KACOYANIS
Title or Position: OWNER
Credential: MD
Phone: 978-821-2922