Healthcare Provider Details

I. General information

NPI: 1255338026
Provider Name (Legal Business Name): MARK MITTELMAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

509 BILTMORE AVE
ASHEVILLE NC
28801-4601
US

IV. Provider business mailing address

PO BOX 654481
DALLAS TX
75265-4481
US

V. Phone/Fax

Practice location:
  • Phone: 828-778-9178
  • Fax:
Mailing address:
  • Phone: 866-860-8755
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number200300668
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number200300668
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number200300668
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: