Provider Demographics
NPI:1871571539
Name:VANASSE, K. GARY (MD)
Entity type:Individual
Prefix:DR
First Name:K.
Middle Name:GARY
Last Name:VANASSE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KIM
Other - Middle Name:JOSEPH
Other - Last Name:VANASSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:75 FRANCIS ST
Mailing Address - Street 2:KARP 5.216
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02115-6110
Mailing Address - Country:US
Mailing Address - Phone:617-732-5840
Mailing Address - Fax:617-732-5706
Practice Address - Street 1:75 FRANCIS ST
Practice Address - Street 2:KARP 5.216
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-6110
Practice Address - Country:US
Practice Address - Phone:617-732-5840
Practice Address - Fax:617-732-5706
Is Sole Proprietor?:No
Enumeration Date:2006-01-04
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPENDING207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
H12136Medicare UPIN