Individual
DR. HENRY R VAILLANCOURT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1030 PRESIDENT AVE, SUITE 104 SOUTHCOAST PHYSICIAN SERVICES INC, FALL RIVER, MA 02720-5923
(508) 676-3411
(508) 235-6656
Mailing address
1030 PRESIDENT AVE, SUITE 104 SOUTHCOAST PHYSICIAN SERVICES INC, FALL RIVER, MA 02720-5923
(508) 676-3411
(508) 235-6656
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
42866
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000021256
BMC HEALTHNET
MA
01
—
0000025599
BLUE SHIELD
RI
01
—
0016215
NEIGHBORHOOD HEALTHPLAN
MA
01
—
004393
BLUE CHIP
RI
01
—
0101462
UNITED HEALTHCARE
MA
05
—
2069199
—
MA
01
—
3684748
HEALTHSOURCE
MA
01
—
60417
HARVARD PILGRIM
MA
01
—
764242
TUFTS
MA
01
—
B10491301
CIGNA
MA
01
—
K08341
BLUE SHIELD
MA
Enumeration date
04/20/2006
Last updated
07/09/2007
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