Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0120X | Pediatric Surgery | 39234 | MA |
NPI | 1396736906 |
---|---|
Provider Name | Dr. Joseph Philip Vacanti |
First Address | Charlestown, MA 02129-9142 |
Second Address | Boston, MA 02114-2621 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2005 |
Last Update Date | 03/01/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2055481 | (05) | MA |
702960 | TUFTS HEALTH PLAN (01) | MA |
A38803 | (02) | |
C05171 | BCBS MA (01) | MA |