Provider Demographics
NPI:1528179827
Name:MITCHELL, DAVID S (DO)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DAVID
Other - Middle Name:S
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:1151 CHURCH RD
Mailing Address - Street 2:
Mailing Address - City:TOMS RIVER
Mailing Address - State:NJ
Mailing Address - Zip Code:08755-2107
Mailing Address - Country:US
Mailing Address - Phone:732-905-8333
Mailing Address - Fax:732-503-4823
Practice Address - Street 1:1151 CHURCH RD
Practice Address - Street 2:
Practice Address - City:TOMS RIVER
Practice Address - State:NJ
Practice Address - Zip Code:08755-2107
Practice Address - Country:US
Practice Address - Phone:732-905-8333
Practice Address - Fax:732-503-4823
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2015-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB05526900207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJE54728Medicare UPIN
NJ624488ZCSMedicare PIN