Provider Demographics
NPI:1497051460
Name:PEARCE, MITCHELL TODD (IDC)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:TODD
Last Name:PEARCE
Suffix:
Gender:M
Credentials:IDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1004 HERMITAGE RD.
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23459-7006
Mailing Address - Country:US
Mailing Address - Phone:757-462-3210
Mailing Address - Fax:757-462-3179
Practice Address - Street 1:1004 HERMITAGE RD.
Practice Address - Street 2:
Practice Address - City:NORFOLK
Practice Address - State:VA
Practice Address - Zip Code:23521-5000
Practice Address - Country:US
Practice Address - Phone:757-462-3210
Practice Address - Fax:757-462-3179
Is Sole Proprietor?:No
Enumeration Date:2011-02-08
Last Update Date:2011-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Corpsman