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General NPI Number Information
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NPI Number | 1679139869
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Entity Type | Individual
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Provider Name | DAIVA MARILYN MITCHELL MD
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Gender | Female
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Dates
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Enumeration Date | 05/14/2019
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Last Update Date | 10/04/2024
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Provider Practice Location Address
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Address Line | 58 16TH ST
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City | WHEELING
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State | WV
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Zip | 26003-3609
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Country | US
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Telephone | 304-231-2090
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Fax |
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Provider Business Mailing Address
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Address Line | 58 16TH ST
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City | WHEELING
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State | WV
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Zip | 26003-3609
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Country | US
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Telephone |
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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 | 207RS0010X
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Taxonomy Name | Sports Medicine (Internal Medicine) Physician
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License Number | 34339
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License Number State | WV
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | MD477553
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License Number State | PA
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