Provider Demographics
NPI:1427361211
Name:MITCHELL WANGH
Entity Type:Organization
Organization Name:MITCHELL WANGH
Other - Org Name:NORTHBORO PSYCHIATRIC ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER OF PRACTICE
Authorized Official - Prefix:DR
Authorized Official - First Name:MICTHELL
Authorized Official - Middle Name:WILLIAM
Authorized Official - Last Name:WANGH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-393-7223
Mailing Address - Street 1:112 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NORTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01532-1914
Mailing Address - Country:US
Mailing Address - Phone:508-393-7223
Mailing Address - Fax:508-393-7026
Practice Address - Street 1:112 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-1914
Practice Address - Country:US
Practice Address - Phone:508-393-7223
Practice Address - Fax:508-393-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-21
Last Update Date:2010-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA0369132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty