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General NPI Number Information
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NPI Number | 1114123643
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Entity Type | Individual
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Provider Name | CARTER WALLACE MITCHELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/22/2007
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Last Update Date | 03/12/2012
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Provider Practice Location Address
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Address Line | 18109 PRINCE PHILIP DR SUITE 325
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City | OLNEY
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State | MD
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Zip | 20832-1519
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Country | US
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Telephone | 301-774-8958
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Fax | 301-774-8959
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Provider Business Mailing Address
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Address Line | PO BOX 418283
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City | BOSTON
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State | MA
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Zip | 02241-8283
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Country | US
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Telephone | 703-558-1544
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207XX0005X
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Taxonomy Name | Sports Medicine (Orthopaedic Surgery) Physician
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License Number | D0067371
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License Number State | MD
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