Provider Demographics
NPI:1225009020
Name:MITCHELL, MARK (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1900 MASS AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2542
Mailing Address - Country:US
Mailing Address - Phone:202-548-6500
Mailing Address - Fax:202-548-7526
Practice Address - Street 1:110 IRVING ST NW RM 5B-18
Practice Address - Street 2:DEPT. OF OB/GYN
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-3017
Practice Address - Country:US
Practice Address - Phone:202-877-7473
Practice Address - Fax:202-877-7393
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2012-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCMD15018207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC010121264Medicaid
DC036306900Medicaid
DC007700300Medicaid
DCB00044Medicare UPIN
DC015919W25Medicare ID - Type UnspecifiedTRAILBLAZER