{
"Npi": {
"NPI": "1861325581",
"EntityType": "Individual",
"ReplacementNPI": null,
"EIN": null,
"IsSoleProprietor": "Y",
"IsOrgSubpart": null,
"ParentOrgLBN": null,
"ParentOrgTIN": null,
"OrgName": null,
"LastName": "MITCHELL",
"FirstName": "MARVIN",
"MiddleName": "ANTHONY",
"NamePrefix": null,
"NameSuffix": null,
"Credential": null,
"OtherOrgName": null,
"OtherOrgNameTypeCode": null,
"OtherLastName": "BELLAMY",
"OtherFirstName": "D'ANN",
"OtherMiddleName": null,
"OtherNamePrefix": null,
"OtherNameSuffix": null,
"OtherCredential": null,
"OtherLastNameTypeCode": "5",
"FirstLineMailingAddress": "508 CHESTER AVE",
"SecondLineMailingAddress": null,
"MailingAddressCityName": "CLIFTON HEIGHTS",
"MailingAddressStateName": "PA",
"MailingAddressPostalCode": "19018-2524",
"MailingAddressCountryCode": "US",
"MailingAddressTelephoneNumber": "267-591-5947",
"MailingAddressFaxNumber": "484-632-4100",
"FirstLinePracticeLocationAddress": "508 CHESTER AVE",
"SecondLinePracticeLocationAddress": null,
"PracticeLocationAddressCityName": "CLIFTON HEIGHTS",
"PracticeLocationAddressStateName": "PA",
"PracticeLocationAddressPostalCode": "19018-2524",
"PracticeLocationAddressCountryCode": "US",
"PracticeLocationAddressTelephoneNumber": "267-591-5947",
"PracticeLocationAddressFaxNumber": "484-632-4100",
"EnumerationDate": "06/03/2026",
"LastUpdateDate": "06/03/2026",
"NPIDeactivationReasonCode": null,
"NPIDeactivationReason": null,
"NPIDeactivationDate": null,
"NPIReactivationDate": null,
"GenderCode": "M",
"Gender": "Male",
"AuthorizedOfficialLastName": null,
"AuthorizedOfficialFirstName": null,
"AuthorizedOfficialMiddleName": null,
"AuthorizedOfficialTitle": null,
"AuthorizedOfficialNamePrefix": null,
"AuthorizedOfficialNameSuffix": null,
"AuthorizedOfficialCredential": null,
"AuthorizedOfficialTelephoneNumber": null,
"Taxonomies": {
"Taxonomy": {
"TaxonomyCode": "374U00000X",
"TaxonomyName": "Home Health Aide",
"LicenseNumber": "374U00000X",
"LicenseNumberStateCode": "PA",
"PrimaryTaxonomySwitch": "Y"
}
},
"HealthcareProviderTaxonomyGroups": {
"HealthcareProviderTaxonomyGroup": {
"HealthcareProviderTaxonomyGroupName": "193400000X SINGLE SPECIALTY GROUP",
"HealthcareProviderTaxonomyGroupDescription": "Single Specialty Group - A business group of one or more individual practitioners, all of who practice with the same area of specialization."
}
}
}
}