Healthcare Provider Details

I. General information

NPI: 1720442825
Provider Name (Legal Business Name): NATALIE MITCHELL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 ELMWOOD AVE # 646
ROCHESTER NY
14642-0001
US

IV. Provider business mailing address

601 ELMWOOD AVE # 646
ROCHESTER NY
14642-0001
US

V. Phone/Fax

Practice location:
  • Phone: 585-275-4711
  • Fax:
Mailing address:
  • Phone: 585-275-2222
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number321741
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0101263302
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: