Provider Demographics
NPI:1740419563
Name:GEORGE C. MITCHELL, MD, PC
Entity Type:Organization
Organization Name:GEORGE C. MITCHELL, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:CONSTANTINE
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:M D
Authorized Official - Phone:508-238-8878
Mailing Address - Street 1:934 WASHINGTON ST
Mailing Address - Street 2:APT. 9
Mailing Address - City:SOUTH EASTON
Mailing Address - State:MA
Mailing Address - Zip Code:02375-1148
Mailing Address - Country:US
Mailing Address - Phone:508-238-8878
Mailing Address - Fax:508-230-8495
Practice Address - Street 1:934 WASHINGTON ST
Practice Address - Street 2:APT. 9
Practice Address - City:SOUTH EASTON
Practice Address - State:MA
Practice Address - Zip Code:02375-1148
Practice Address - Country:US
Practice Address - Phone:508-238-8878
Practice Address - Fax:508-230-8495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA38174261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAB75125Medicare UPIN