MEDICARE: DR. ERIC RAY MITCHELL M.D.

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	207V00000X	Obstetrics & Gynecology Physician	271192	NY

General Provider Information

NPI Number	:	1518194208
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERIC RAY MITCHELL M.D.

Provider Business Mailing Address
First Line	:	301 W 57TH ST
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10019-3114
Country	:	US
Telephone Number	:	910-736-3762
Fax Number	:

Provider Business Practice Location Address
First Line	:	1107 5TH AVE # 1E
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10128-0145
Country	:	US
Telephone Number	:	212-410-6700
Fax Number	:

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

Provider Enumeration Date	:	06/19/2009
Last Update Date	:	03/20/2018

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