1982406500 NPI number — MACKENZIE AUGUSTA MITCHELL MD, MA

Table of content: MACKENZIE AUGUSTA MITCHELL MD, MA (NPI 1982406500)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982406500 NPI number — MACKENZIE AUGUSTA MITCHELL MD, MA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MITCHELL
Provider First Name:
MACKENZIE
Provider Middle Name:
AUGUSTA
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD, MA
Provider Gender Code:
F

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:
1982406500
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/25/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1176 FIFTH AVENUE
Provider Second Line Business Mailing Address:
BOX 1170 9TH FLOOR ROOM 19
Provider Business Mailing Address City Name:
NEW YORK CITY
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
10029
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1176 FIFTH AVENUE
Provider Second Line Business Practice Location Address:
BOX 1170 9TH FLOOR ROOM 19
Provider Business Practice Location Address City Name:
NEW YORK CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
10029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
212-241-8528
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/25/2025

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: 390200000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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