Provider Demographics
NPI:1124055363
Name:WACHTER, STUART (MD)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:
Last Name:WACHTER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:JOHN CUMING BLDG, 131 ORNAC
Mailing Address - Street 2:SUITE 580
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-4191
Mailing Address - Country:US
Mailing Address - Phone:978-371-9690
Mailing Address - Fax:978-371-9691
Practice Address - Street 1:JOHN CUMING BLDG, 131 ORNAC
Practice Address - Street 2:SUITE 580
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-4191
Practice Address - Country:US
Practice Address - Phone:978-371-9690
Practice Address - Fax:978-371-9691
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MA563982084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAJ05543OtherBCBS PROVIDER NUMBER
MAA58439Medicare UPIN
MAJ05543OtherBCBS PROVIDER NUMBER