Active NPI
Edwin Mikkelsen, M.D.
- Psychiatry Physician
- Wellesley, MA
National Provider Identifier
1992756530
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- 36837
- Practice address
- 67 Yarmouth Rd
Wellesley, MA 02481-1248 - Phone
- (617) 790-4248
- Fax
- (781) 237-5953
- NPI assigned
- May 15, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | 36837 | MA | Primary |
Addresses
Primary practice location
67 Yarmouth Rd
Wellesley, MA 02481-1248
Mailing address
67 Yarmouth Rd
Wellesley, MA 02481-1248
Phone (617) 790-4248
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 36837 | MA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1147651200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1992756530",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "67 YARMOUTH RD",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024811248",
"telephone_number": "617-790-4248",
"fax_number": "781-237-5953"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "67 YARMOUTH RD",
"city": "WELLESLEY",
"state": "MA",
"postal_code": "024811248",
"telephone_number": "617-790-4248",
"fax_number": "781-237-5953"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKKELSEN",
"first_name": "EDWIN",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-05-15",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "MA",
"license": "36837",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Wellesley, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.