Provider Demographics
NPI:1003818204
Name:SHMOKLER, MITCHELL F (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:F
Last Name:SHMOKLER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:450 PARK WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BROOMALL
Mailing Address - State:PA
Mailing Address - Zip Code:19008-4202
Mailing Address - Country:US
Mailing Address - Phone:484-422-8080
Mailing Address - Fax:484-422-8073
Practice Address - Street 1:301 W CHESTER PIKE
Practice Address - Street 2:SUITE 201
Practice Address - City:HAVERTOWN
Practice Address - State:PA
Practice Address - Zip Code:19083-4530
Practice Address - Country:US
Practice Address - Phone:610-853-2900
Practice Address - Fax:610-853-2980
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2010-07-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
PAMD023880E207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0008557550001Medicaid
080084180OtherRAILROAD MEDICARE
PA080084180Medicare PIN
079223K9LMedicare PIN