Provider Demographics
NPI:1376563171
Name:MITCH, ALISON M (MD)
Entity Type:Individual
Prefix:DR
First Name:ALISON
Middle Name:M
Last Name:MITCH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 CEDARWOOD RD
Mailing Address - Street 2:
Mailing Address - City:WYOMISSING
Mailing Address - State:PA
Mailing Address - Zip Code:19610-1910
Mailing Address - Country:US
Mailing Address - Phone:610-484-4068
Mailing Address - Fax:
Practice Address - Street 1:1011 BERK RD
Practice Address - Street 2:
Practice Address - City:LEESPORT
Practice Address - State:PA
Practice Address - Zip Code:19533-8705
Practice Address - Country:US
Practice Address - Phone:610-376-4841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD420898208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
20033593OtherAMERIHEALTH ADMINISTRATOR
50040136OtherCAPITAL BLUE CROSS CAPITA
0001491263OtherHIGHMARK BLUE SHIELD
2180795000OtherINDEPENDENCE BLUE CROSS
3000215OtherKEYSTONE HEALTH PLAN CENT
PA0019624550002Medicaid
000000172928OtherTHREE RIVERS UNISON
20033593OtherAMERIHEALTH MERCY
2180795000OtherKEYSTONE HEALTH PLAN EAST
352683OtherHEALTH AMERICA HEALTH AS
20033593OtherAMERIHEALTH ADMINISTRATOR
PA070901Medicare PIN