Provider Demographics
NPI:1245247139
Name:VACHON, NICHOLAS SCOTT (DPM)
Entity type:Individual
Prefix:DR
First Name:NICHOLAS
Middle Name:SCOTT
Last Name:VACHON
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 1:50 UNION ST
Mailing Address - Street 2:
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-1534
Mailing Address - Country:US
Mailing Address - Phone:207-667-2523
Mailing Address - Fax:207-667-7307
Practice Address - Street 1:318 MAIN ST
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-0662
Practice Address - Country:US
Practice Address - Phone:207-667-2523
Practice Address - Fax:207-667-7307
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME198213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEE400353482Medicare PIN
T31380Medicare UPIN