Provider Demographics
NPI:1124197090
Name:MITCHELL, LEWIS DEAN (MD)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:DEAN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:DEAN
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 14883
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27415-4883
Mailing Address - Country:US
Mailing Address - Phone:336-379-1156
Mailing Address - Fax:336-370-0442
Practice Address - Street 1:301 E WENDOVER AVE
Practice Address - Street 2:SUITE 215
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1230
Practice Address - Country:US
Practice Address - Phone:336-379-1156
Practice Address - Fax:336-370-0442
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2021-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC28427207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC59622OtherBCBS OF NC
NC8959622Medicaid
NC881OtherPARTNERS MEDICARE
NC28254OtherMEDCOST
NC59622OtherBCBS OF NC
NC8959622Medicaid
NC203660DMedicare PIN