Provider Demographics
NPI:1518032648
Name:MITCHELL, DAVID JAMES (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAMES
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 1:2315 MYRTLE ST STE G30
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16502-4610
Mailing Address - Country:US
Mailing Address - Phone:814-452-5504
Mailing Address - Fax:814-452-5514
Practice Address - Street 1:2315 MYRTLE ST STE G30
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16502-4610
Practice Address - Country:US
Practice Address - Phone:814-452-5504
Practice Address - Fax:814-452-5514
Is Sole Proprietor?:No
Enumeration Date:2006-11-22
Last Update Date:2023-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.086892207V00000X
IN01079029A207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2973573Medicaid
OH2821558OtherGRAND LAKE OB/GYN GROUP MEDICAID
OHH024451OtherMEDICARE INDIVIDUAL PTAN
OH1447288717OtherGRAND LAKE OB/GYN GROUP NPI