1225009020 NPI number — DR. MARK MITCHELL MD

Table of content: DR. MARK MITCHELL MD (NPI 1225009020)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225009020 NPI number — DR. MARK MITCHELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
MARK
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1225009020
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/02/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 MASS AVE SE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20003-2542
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-548-6500
Provider Business Mailing Address Fax Number:
202-548-7526

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
110 IRVING ST NW RM 5B-18
Provider Second Line Business Practice Location Address:
DEPT. OF OB/GYN
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20010-3017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-877-7473
Provider Business Practice Location Address Fax Number:
202-877-7393
Provider Enumeration Date:
01/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  MD15018 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 010121264 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 036306900 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 007700300 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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