1881792158 NPI number — CHRISTINE A. MITCHELL, DO,NMMOMM,FP,LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881792158 NPI number — CHRISTINE A. MITCHELL, DO,NMMOMM,FP,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTINE A. MITCHELL, DO,NMMOMM,FP,LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1881792158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4949 TRINITY DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOS ALAMOS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
87544-1857
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-280-0379
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 W COLD SPRING LN STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21210-2800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-280-7390
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MITCHELL
Authorized Official First Name:
CHRISTINE
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
MANAGING MEMBER, PHYSICIAN
Authorized Official Telephone Number:
443-280-0379

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X , with the licence number:  H0063949 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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