Healthcare Provider Details

I. General information

NPI: 1811996044
Provider Name (Legal Business Name): REGINA MARIE MITCHELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REGINA MARIE LA BARBERA M.D.

II. Dates (important events)

Enumeration Date: 07/19/2005
Last Update Date: 11/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 S HANOVER ST
BALTIMORE MD
21225
US

IV. Provider business mailing address

3001 S HANOVER ST
BALTIMORE MD
21225
US

V. Phone/Fax

Practice location:
  • Phone: 410-350-8213
  • Fax:
Mailing address:
  • Phone: 410-350-8213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number0101840507
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberD0069773
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: