Provider Demographics
NPI:1629134622
Name:MITCHELL, HARRISON (MD)
Entity Type:Individual
Prefix:DR
First Name:HARRISON
Middle Name:
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 1:2368 ADAM CLAYTON POWELL JR BLVD
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10030-2250
Mailing Address - Country:US
Mailing Address - Phone:212-690-3200
Mailing Address - Fax:212-690-1298
Practice Address - Street 1:2368 ADAM CLAYTON POWELL JR BLVD
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10030-2250
Practice Address - Country:US
Practice Address - Phone:212-690-3200
Practice Address - Fax:212-690-1298
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY193957207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
17J761Medicare PIN