Provider Demographics
NPI:1700037751
Name:MITCHELL, MARY K (DO)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:K
Other - Last Name:STORY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:PO BOX 783311
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-3311
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3691 CRESCENT CT E
Practice Address - Street 2:SUITE 100
Practice Address - City:WHITEHALL
Practice Address - State:PA
Practice Address - Zip Code:18052-3433
Practice Address - Country:US
Practice Address - Phone:610-434-4294
Practice Address - Fax:610-439-1224
Is Sole Proprietor?:No
Enumeration Date:2008-10-08
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS015153207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine