Provider Demographics
NPI:1396736906
Name:VACANTI, JOSEPH PHILIP (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:PHILIP
Last Name:VACANTI
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Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 9142
Mailing Address - Street 2:MASS GENERAL PHYSICIAN ORGANIZATION
Mailing Address - City:CHARLESTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02129-9142
Mailing Address - Country:US
Mailing Address - Phone:617-724-1725
Mailing Address - Fax:617-726-7593
Practice Address - Street 1:55 FRUIT ST
Practice Address - Street 2:WRN 1157
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02114-2621
Practice Address - Country:US
Practice Address - Phone:617-724-1725
Practice Address - Fax:617-726-7593
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2013-01-03
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Provider Licenses
StateLicense IDTaxonomies
MA392342086S0120X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0120XAllopathic & Osteopathic PhysiciansSurgeryPediatric Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2055481Medicaid
MA702960OtherTUFTS HEALTH PLAN
MAC05171OtherBCBS MA
MAC05171OtherBCBS MA
MA702960OtherTUFTS HEALTH PLAN