Provider Demographics
NPI:1982688784
Name:IACONO, VINCENT (MD)
Entity Type:Individual
Prefix:
First Name:VINCENT
Middle Name:
Last Name:IACONO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 WASHINGTON STREET
Mailing Address - Street 2:STE 200
Mailing Address - City:NORTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02356-1010
Mailing Address - Country:US
Mailing Address - Phone:508-205-9630
Mailing Address - Fax:508-796-2610
Practice Address - Street 1:3 WASHINGTON STREET
Practice Address - Street 2:STE 200
Practice Address - City:NORTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02356-1010
Practice Address - Country:US
Practice Address - Phone:508-205-9630
Practice Address - Fax:508-796-2610
Is Sole Proprietor?:No
Enumeration Date:2005-12-05
Last Update Date:2016-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA34417174400000X, 207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0166391Medicaid
MAC2020701ROtherMEDICARE NGS
MA0166391Medicaid