Healthcare Provider Details

I. General information

NPI: 1871588202
Provider Name (Legal Business Name): DR. JOHN JOSEPH MITCHERLING
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 07/09/2007
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:
Title or Position:
Credential:
Phone: