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General NPI Number Information
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NPI Number | 1417043902
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Entity Type | Individual
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Provider Name | ESAU MITCHELL PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/04/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1400 BLACKHORSE HILL RD
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City | COATESVILLE
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State | PA
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Zip | 19320
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Country | US
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Telephone | 610-384-7711
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Fax |
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Provider Business Mailing Address
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Address Line | 216 N. EVERHART AVE APT. A
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City | WEST CHESTER
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State | PA
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Zip | 19380
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Country | US
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Telephone | 610-719-0621
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | MA001966L
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License Number State | PA
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