Healthcare Provider Details

I. General information

NPI: 1376740365
Provider Name (Legal Business Name): MITCHERLING,MITCHERLING & JOHNSON P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/02/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 E NORTHERN PKWY SUITE 108
BALTIMORE MD
21239-2113
US

IV. Provider business mailing address

1900 E NORTHERN PKWY SUITE 108
BALTIMORE MD
21239-2113
US

V. Phone/Fax

Practice location:
  • Phone: 410-323-3900
  • Fax: 410-323-2267
Mailing address:
  • Phone: 410-323-3900
  • Fax: 410-323-2267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number4702
License Number StateMD

VIII. Authorized Official

Name: DR. JOHN J MITCHERLING
Title or Position: ORAL SURGEON
Credential: DDS
Phone: 410-323-3900