Healthcare Provider Details

I. General information

NPI: 1225009020
Provider Name (Legal Business Name): MARK MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2006
Last Update Date: 07/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 IRVING ST NW RM 5B-18 DEPT. OF OB/GYN
WASHINGTON DC
20010-3017
US

IV. Provider business mailing address

1900 MASS AVE SE
WASHINGTON DC
20003-2542
US

V. Phone/Fax

Practice location:
  • Phone: 202-877-7473
  • Fax: 202-877-7393
Mailing address:
  • Phone: 202-548-6500
  • Fax: 202-548-7526

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberMD15018
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: