Provider Demographics
NPI:1295918969
Name:MITCHELL J WACHTEL DPM PC
Entity type:Organization
Organization Name:MITCHELL J WACHTEL DPM PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MITCHELL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WACHTEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:978-794-8406
Mailing Address - Street 1:451 ANDOVER ST
Mailing Address - Street 2:STE 300
Mailing Address - City:NORTH ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01845-5044
Mailing Address - Country:US
Mailing Address - Phone:978-794-8406
Mailing Address - Fax:
Practice Address - Street 1:451 ANDOVER ST STE 202
Practice Address - Street 2:
Practice Address - City:NORTH ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01845-5069
Practice Address - Country:US
Practice Address - Phone:978-794-8406
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-17
Last Update Date:2024-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA001978332B00000X
213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA4182870001Medicare NSC