Healthcare Provider Details

I. General information

NPI: 1295918969
Provider Name (Legal Business Name): MITCHELL J WACHTEL DPM PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 ANDOVER ST STE 202
NORTH ANDOVER MA
01845-5069
US

IV. Provider business mailing address

451 ANDOVER ST STE 300
NORTH ANDOVER MA
01845-5044
US

V. Phone/Fax

Practice location:
  • Phone: 978-794-8406
  • Fax:
Mailing address:
  • Phone: 978-794-8406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number001978
License Number StateMA

VIII. Authorized Official

Name: DR. MITCHELL J WACHTEL
Title or Position: OWNER/PRESIDENT
Credential: DPM
Phone: 978-794-8406