Provider Demographics
NPI:1194791186
Name:MITCHELL, WILLIAM A JR (MD)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:MITCHELL
Suffix:JR
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:65 WALNUT ST
Mailing Address - Street 2:SUITE 440
Mailing Address - City:WELLESLEY
Mailing Address - State:MA
Mailing Address - Zip Code:02481-2118
Mailing Address - Country:US
Mailing Address - Phone:781-235-9089
Mailing Address - Fax:781-489-6146
Practice Address - Street 1:65 WALNUT ST STE 440
Practice Address - Street 2:
Practice Address - City:WELLESLEY
Practice Address - State:MA
Practice Address - Zip Code:02481-2196
Practice Address - Country:US
Practice Address - Phone:781-235-9089
Practice Address - Fax:781-237-5121
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2014-11-20
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MA52543207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3007561Medicaid
MA69218OtherFALLON COMMUN HEALTH PLAN
MA2438941OtherAETNA
MAJ03422OtherBLUE CROSS BLUE SHIELD
MA172421OtherHARVARD PILGRIM
MAP00271550OtherRAILROAD MEDICARE
MA052543OtherTUFTS HEALTH PLAN
MA2438941OtherAETNA
MA69218OtherFALLON COMMUN HEALTH PLAN
MAB77020Medicare UPIN