Provider Demographics
NPI:1528354792
Name:VAICKUS, LOUIS (MD)
Entity type:Individual
Prefix:DR
First Name:LOUIS
Middle Name:
Last Name:VAICKUS
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 1:22 FRANKLIN RODGERS RD
Mailing Address - Street 2:
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043-2664
Mailing Address - Country:US
Mailing Address - Phone:781-740-9028
Mailing Address - Fax:
Practice Address - Street 1:22 FRANKLIN RODGERS RD
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-2664
Practice Address - Country:US
Practice Address - Phone:781-740-9028
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-25
Last Update Date:2011-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY176571-1207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine