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General NPI Number Information
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NPI Number | 1609878065
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Entity Type | Individual
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Provider Name | HENRY D MITCHESON MD
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Gender | Male
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Dates
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Enumeration Date | 08/15/2005
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Last Update Date | 08/09/2023
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Provider Practice Location Address
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Address Line | 521 MOUNT AUBURN ST STE 201
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City | WATERTOWN
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State | MA
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Zip | 02472-4153
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Country | US
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Telephone | 617-926-1200
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Fax |
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Provider Business Mailing Address
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Address Line | 521 MT. AUBURN ST., SUITE 201
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City | WATERTOWN
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State | MA
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Zip | 02472
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Country | US
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Telephone | 617-926-1200
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number | 48820
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License Number State | MA
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