Provider Demographics
NPI:1548232507
Name:MITCHELL, ERIC I (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:I
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 1:34 GILMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-0000
Mailing Address - Country:US
Mailing Address - Phone:207-941-8300
Mailing Address - Fax:207-947-3134
Practice Address - Street 1:34 GILMAN ROAD
Practice Address - Street 2:
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-0000
Practice Address - Country:US
Practice Address - Phone:207-941-8300
Practice Address - Fax:207-947-3134
Is Sole Proprietor?:No
Enumeration Date:2006-02-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD036411L207X00000X
NY232143-1207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02459474Medicaid
PA0014918340006Medicaid
PA0014918340006Medicaid
B96697Medicare UPIN