Healthcare Provider Details

I. General information

NPI: 1548232507
Provider Name (Legal Business Name): ERIC I. MITCHELL M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/03/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

34 GILMAN ROAD
BANGOR ME
04401-0000
US

IV. Provider business mailing address

34 GILMAN ROAD
BANGOR ME
04401-0000
US

V. Phone/Fax

Practice location:
  • Phone: 207-941-8300
  • Fax: 207-947-3134
Mailing address:
  • Phone: 207-941-8300
  • Fax: 207-947-3134

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberMD036411L
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number232143-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: