Healthcare Provider Details

I. General information

NPI: 1083614481
Provider Name (Legal Business Name): DOUGLAS MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2005
Last Update Date: 10/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6934 AVIATION BLVD SUITE B
GLEN BURNIE MD
21061-2593
US

IV. Provider business mailing address

7250 PARKWAY DR STE 500
HANOVER MD
21076-1343
US

V. Phone/Fax

Practice location:
  • Phone: 443-949-0814
  • Fax:
Mailing address:
  • Phone: 410-216-6481
  • Fax: 410-280-6515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberD39037
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: