Healthcare Provider Details

I. General information

NPI: 1467456921
Provider Name (Legal Business Name): JOHN E MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/11/2005
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

724 S NEW ST
DOVER DE
19904-3540
US

IV. Provider business mailing address

640 S. STATE STREET MAIL CODE 3055
DOVER DE
19901-3530
US

V. Phone/Fax

Practice location:
  • Phone: 302-674-4070
  • Fax: 302-672-2315
Mailing address:
  • Phone: 302-674-4070
  • Fax: 302-672-2315

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberC1-0026239
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: