Healthcare Provider Details

I. General information

NPI: 1265768832
Provider Name (Legal Business Name): RICHARD JOSEPH MITCHELL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/02/2009
Last Update Date: 09/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 PLAZA DR SUITE 240
BELLE VERNON PA
15012-4019
US

IV. Provider business mailing address

800 PLAZA DR SUITE 240
BELLE VERNON PA
15012-4019
US

V. Phone/Fax

Practice location:
  • Phone: 724-379-5860
  • Fax: 724-379-5874
Mailing address:
  • Phone: 724-379-5860
  • Fax: 724-379-5874

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License Number2010015947
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: