Provider Demographics
NPI:1174795025
Name:NICHOLAS S. VACHON, D.P.M., P.A.
Entity type:Organization
Organization Name:NICHOLAS S. VACHON, D.P.M., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:VACHON
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:207-667-2523
Mailing Address - Street 1:PO BOX 662
Mailing Address - Street 2:318 MAIN STREET
Mailing Address - City:ELLSWORTH
Mailing Address - State:ME
Mailing Address - Zip Code:04605-0662
Mailing Address - Country:US
Mailing Address - Phone:207-667-2523
Mailing Address - Fax:207-667-7307
Practice Address - Street 1:318 MAIN STREET
Practice Address - Street 2:
Practice Address - City:ELLSWORTH
Practice Address - State:ME
Practice Address - Zip Code:04605-0662
Practice Address - Country:US
Practice Address - Phone:207-667-2523
Practice Address - Fax:207-667-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-01
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME198213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME4226990001OtherMEDICARE PTAN
ME132930000Medicaid
ME4226990001OtherMEDICARE PTAN
ME132930000Medicaid
ME4226990001Medicare NSC