MEDICARE: MATTHEW J. MITSCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	0101052465	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	333299	OTHER	VA	MAMSI
2	54-1816313	OTHER	VA	VA. HEALTH NETWORK
3	44740849	OTHER	VA	MULTI-PLAN PPO
4	54-1816313	OTHER	VA	AARP
5	0499149	OTHER	VA	GHI
6	142942XX	OTHER	VA	PREFERRED CARE
7	54-1816313	OTHER	VA	TRICARE
8	54-1816313	OTHER	VA	MAILHANDLERS
9	600212807	OTHER	VA	CIGNA
10	54-1816313	OTHER	VA	AETNA
11	54-1816313	OTHER	VA	UNITED HEALTHCARE
12	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
13	380172	OTHER	VA	ANTHEM
14	54-1816313	OTHER	VA	PRIORITY HEALTHCARE INC.
15	3078121	OTHER	VA	CIGNA PPO
16	61240	OTHER	VA	OPTIMA
17	843259	OTHER	VA	FIRST HEALTH

General Provider Information

NPI Number	:	1083624084
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW J. MITSCH MD

Provider Business Mailing Address
First Line	:	SUITE 6
Second Line	:	1821 OLD DONATION PARKWAY
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-496-4864
Fax Number	:	757-496-4942

Provider Business Practice Location Address
First Line	:	SUITE 6
Second Line	:	1821 OLD DONATION PARKWAY
City	:	VIRGINIA BCH
State	:	VA
Zip	:	23454-3033
Country	:	US
Telephone Number	:	757-496-4864
Fax Number	:	757-496-4942

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	07/30/2008

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