Healthcare Provider Details

I. General information

NPI: 1528907284
Provider Name (Legal Business Name): CORLISS MITCHELL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 GLEN AVE STE 104
SALISBURY MD
21804-5256
US

IV. Provider business mailing address

600 GLEN AVE STE 104
SALISBURY MD
21804-5256
US

V. Phone/Fax

Practice location:
  • Phone: 410-543-9111
  • Fax:
Mailing address:
  • Phone:
  • Fax: 410-543-9115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberC0010440
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: