Provider Demographics
NPI:1215212543
Name:MITCHELL, BOBBY (MSC)
Entity Type:Individual
Prefix:
First Name:BOBBY
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MSC
Other - Prefix:
Other - First Name:BJ
Other - Middle Name:
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSC
Mailing Address - Street 1:PO BOX 507
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MD
Mailing Address - Zip Code:20763-0507
Mailing Address - Country:US
Mailing Address - Phone:240-422-2123
Mailing Address - Fax:
Practice Address - Street 1:9228 VOLLMERHAUSEN RD
Practice Address - Street 2:
Practice Address - City:JESSUP
Practice Address - State:MD
Practice Address - Zip Code:20794-9518
Practice Address - Country:US
Practice Address - Phone:240-422-2123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-18
Last Update Date:2011-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other