MEDICARE: DREW CHRISTIAN MITCHELL 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	390200000X	Student in an Organized Health Care Education/Training Program	284580	MA
2	390200000X	Student in an Organized Health Care Education/Training Program		NM
3	390200000X	Student in an Organized Health Care Education/Training Program
4	207NP0225X	Pediatric Dermatology Physician	MT232022	PA

General Provider Information

NPI Number	:	1114547932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DREW CHRISTIAN MITCHELL MD

Provider Business Mailing Address
First Line	:	3401 CIVIC CENTER BLVD
Second Line	:	DIVISION OF PEDIATRIC DERMATOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0001
Country	:	US
Telephone Number	:	215-590-2169
Fax Number	:

Provider Business Practice Location Address
First Line	:	3401 CIVIC CENTER BLVD
Second Line	:	DIVISION OF PEDIATRIC DERMATOLOGY
City	:	PHILADELPHIA
State	:	PA
Zip	:	19104-0001
Country	:	US
Telephone Number	:	215-590-2169
Fax Number	:

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

Provider Enumeration Date	:	04/22/2020
Last Update Date	:	06/03/2024

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