Provider Demographics
NPI:1609878065
Name:MITCHESON, HENRY D (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:D
Last Name:MITCHESON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:H
Other - Middle Name:DAVID
Other - Last Name:MITCHESON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:521 MT. AUBURN ST., SUITE 201
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472
Mailing Address - Country:US
Mailing Address - Phone:617-926-1200
Mailing Address - Fax:
Practice Address - Street 1:521 MOUNT AUBURN ST STE 201
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4153
Practice Address - Country:US
Practice Address - Phone:617-926-1200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2023-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA48820208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0177938Medicaid
A54803Medicare UPIN
MAE05695Medicare PIN