Provider Demographics
NPI:1275597114
Name:STICKLER, MITCHELL CHRISTOPHER (MD)
Entity Type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:CHRISTOPHER
Last Name:STICKLER
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 1:750 KINGS HIGHWAY
Mailing Address - Street 2:STE 110
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-644-6400
Mailing Address - Fax:302-644-6409
Practice Address - Street 1:750 KINGS HIGHWAY
Practice Address - Street 2:STE 110
Practice Address - City:LEWES
Practice Address - State:DE
Practice Address - Zip Code:19958
Practice Address - Country:US
Practice Address - Phone:302-644-6400
Practice Address - Fax:302-644-6409
Is Sole Proprietor?:No
Enumeration Date:2006-04-17
Last Update Date:2020-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEC10003715207N00000X
DEC1-0003715207NS0135X, 207ND0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
No207N00000XAllopathic & Osteopathic PhysiciansDermatology
No207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE0000431701Medicaid
000C97C75Medicare ID - Type Unspecified
E87878Medicare UPIN