Provider Demographics
NPI:1740373737
Name:KACOYANIS, GEORGE P (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:P
Last Name:KACOYANIS
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Gender:M
Credentials:MD
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Mailing Address - Street 1:35 UNITED DR
Mailing Address - Street 2:STE 102
Mailing Address - City:W BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1027
Mailing Address - Country:US
Mailing Address - Phone:508-238-8646
Mailing Address - Fax:508-230-9772
Practice Address - Street 1:500 CUMMINGS CTR
Practice Address - Street 2:STE 1800
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6141
Practice Address - Country:US
Practice Address - Phone:978-821-2922
Practice Address - Fax:978-921-1534
Is Sole Proprietor?:No
Enumeration Date:2006-10-02
Last Update Date:2017-09-27
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Provider Licenses
StateLicense IDTaxonomies
MA46099208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0142786Medicaid
MA0142786Medicaid
A54010Medicare UPIN