Provider Demographics
NPI:1588846232
Name:MATHIS, MITCHELL VINCENT JR (MD)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:VINCENT
Last Name:MATHIS
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:10630 LITTLE PATUXENT PARKWAY
Mailing Address - Street 2:SUITE 209
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044
Mailing Address - Country:US
Mailing Address - Phone:410-740-8066
Mailing Address - Fax:410-740-8068
Practice Address - Street 1:10630 LITTLE PATUXENT PARKWAY
Practice Address - Street 2:SUITE 209
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044
Practice Address - Country:US
Practice Address - Phone:410-740-8066
Practice Address - Fax:410-740-8068
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2012-04-05
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Provider Licenses
StateLicense IDTaxonomies
MDD0051608103TP0016X, 2084P0805X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0805XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyGeriatric Psychiatry
No103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)