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General NPI Number Information
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NPI Number | 1114189115
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Entity Type | Individual
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Provider Name | MICHAEL DEAN MITCHELL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 03/26/2025
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Provider Practice Location Address
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Address Line | 572 ROUTE 6 SUITE 2
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City | MAHOPAC
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State | NY
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Zip | 10541
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Country | US
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Telephone | 845-628-3530
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Fax | 845-628-3548
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Provider Business Mailing Address
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Address Line | 572 ROUTE 6 SUITE 2
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City | MAHOPAC
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State | NY
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Zip | 10541
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Country | US
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Telephone | 845-628-3530
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Fax | 845-628-3548
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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 | 2083A0300X
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Taxonomy Name | Addiction Medicine (Preventive Medicine) Physician
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License Number | 162568
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 162568
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License Number State | NY
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