Healthcare Provider Details

I. General information

NPI: 1316391865
Provider Name (Legal Business Name): ANDREW MITCHELL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2016
Last Update Date: 04/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1253 WALTER ST SE
WASHINGTON DC
20003-1449
US

IV. Provider business mailing address

PO BOX 15828
CHEVY CHASE MD
20825-5828
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-5951
  • Fax:
Mailing address:
  • Phone: 202-596-5951
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: