Provider Demographics
NPI:1003132093
Name:CONSTANT, MITCHELL (PA)
Entity Type:Individual
Prefix:MR
First Name:MITCHELL
Middle Name:
Last Name:CONSTANT
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:7247 WILD OLIVE AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87113-2077
Mailing Address - Country:US
Mailing Address - Phone:505-797-0501
Mailing Address - Fax:
Practice Address - Street 1:1640 OLD PECOS TRAIL, SUITE H
Practice Address - Street 2:HEALTH FRONT, PC
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505
Practice Address - Country:US
Practice Address - Phone:505-992-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant