Provider Demographics
NPI:1255678785
Name:VASCULAR AND VEIN PHYSICIAN GROUP PC
Entity Type:Organization
Organization Name:VASCULAR AND VEIN PHYSICIAN GROUP PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:GONSALVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:978-837-3317
Mailing Address - Street 1:380 MERRIMACK ST
Mailing Address - Street 2:SUITE 1C
Mailing Address - City:METHUEN
Mailing Address - State:MA
Mailing Address - Zip Code:01844
Mailing Address - Country:US
Mailing Address - Phone:978-837-3317
Mailing Address - Fax:978-837-3318
Practice Address - Street 1:380 MERRIMACK ST
Practice Address - Street 2:SUITE 1C
Practice Address - City:METHUEN
Practice Address - State:MA
Practice Address - Zip Code:01844
Practice Address - Country:US
Practice Address - Phone:978-837-3317
Practice Address - Fax:978-837-3318
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:VASCULAR AND VEIN ASSOCIATES PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-03
Last Update Date:2017-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110072850AMedicaid
NH30218369Medicaid
0012924Medicare PIN