Provider Demographics
NPI:1528052115
Name:WASKIN, MITCHELL R (DPM)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:R
Last Name:WASKIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1465 JOHNSTON WILLIS DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23235-4730
Mailing Address - Country:US
Mailing Address - Phone:804-320-3668
Mailing Address - Fax:804-320-2600
Practice Address - Street 1:1465 JOHNSTON WILLIS DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23235-4730
Practice Address - Country:US
Practice Address - Phone:804-320-3668
Practice Address - Fax:804-320-2600
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2018-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0103000676213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010103720Medicaid
P00201376Medicare PIN
VA010103720Medicaid
VA00W171F01Medicare ID - Type Unspecified