MEDICARE: CHARLES ANDREW MICK M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207X00000X	Orthopaedic Surgery Physician	80108	MA

General Provider Information

NPI Number	:	1407895931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES ANDREW MICK M.D.

Provider Business Mailing Address
First Line	:	54 WASHINGTON AVE
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-2823
Country	:	US
Telephone Number	:	413-582-0330
Fax Number	:

Provider Business Practice Location Address
First Line	:	766 N KING ST
Second Line	:
City	:	NORTHAMPTON
State	:	MA
Zip	:	01060-1142
Country	:	US
Telephone Number	:	413-582-0330
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	06/01/2011

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