Provider Demographics
NPI:1578520466
Name:VERNACCHIO, LOUIS (MD, MSC)
Entity Type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:VERNACCHIO
Suffix:
Gender:M
Credentials:MD, MSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:69 PHILLIPS BROOKS RD
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2021
Mailing Address - Country:US
Mailing Address - Phone:781-251-9697
Mailing Address - Fax:
Practice Address - Street 1:319 LONGWOOD AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-5728
Practice Address - Country:US
Practice Address - Phone:617-277-7320
Practice Address - Fax:617-277-7834
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA151597208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3156820Medicaid
MA3156820Medicaid