Provider Demographics
NPI:1508845223
Name:WACHS, M DENNIS (MD)
Entity Type:Individual
Prefix:
First Name:M
Middle Name:DENNIS
Last Name:WACHS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:MARVIN
Other - Middle Name:DENNIS
Other - Last Name:WACHS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:700 LAKE AVE
Mailing Address - Street 2:SUITE ONE
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03103-2734
Mailing Address - Country:US
Mailing Address - Phone:603-669-5454
Mailing Address - Fax:603-641-0360
Practice Address - Street 1:700 LAKE AVE
Practice Address - Street 2:SUITE ONE
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03103-2734
Practice Address - Country:US
Practice Address - Phone:603-669-5454
Practice Address - Fax:603-641-0360
Is Sole Proprietor?:No
Enumeration Date:2006-01-11
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH5197207X00000X
NC15607207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH00000397Medicaid
NH00000397Medicaid
NH0389700001Medicare NSC
NHE10025Medicare UPIN