Provider Demographics
NPI:1477521540
Name:MITCHELL, GRANT E (MD)
Entity Type:Individual
Prefix:
First Name:GRANT
Middle Name:E
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 1:297 KNOLLWOOD RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:WHITE PLAINS
Mailing Address - State:NY
Mailing Address - Zip Code:10607-1833
Mailing Address - Country:US
Mailing Address - Phone:914-287-0771
Mailing Address - Fax:914-682-7518
Practice Address - Street 1:297 KNOLLWOOD RD
Practice Address - Street 2:SUITE 305
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10607-1833
Practice Address - Country:US
Practice Address - Phone:914-287-0771
Practice Address - Fax:914-287-0771
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2011-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1719012084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY57F601Medicare ID - Type Unspecified
E51320Medicare UPIN