Provider Demographics
NPI:1760469092
Name:MITCHARD, WILLIAM C (DPM)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:C
Last Name:MITCHARD
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-6030
Mailing Address - Country:US
Mailing Address - Phone:203-237-0524
Mailing Address - Fax:203-238-4782
Practice Address - Street 1:576 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-6030
Practice Address - Country:US
Practice Address - Phone:203-237-0524
Practice Address - Fax:203-238-4782
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-28
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000126213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T22495Medicare UPIN
CT480000199Medicare ID - Type Unspecified