Provider Demographics
NPI:1952442253
Name:MITCHELL, JOHN DAVID (MD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:DAVID
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8218 WISCONSIN AVE
Mailing Address - Street 2:SUITE P-10
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3107
Mailing Address - Country:US
Mailing Address - Phone:301-656-2027
Mailing Address - Fax:301-656-9690
Practice Address - Street 1:8218 WISCONSIN AVE
Practice Address - Street 2:SUITE P-10
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3107
Practice Address - Country:US
Practice Address - Phone:301-656-2027
Practice Address - Fax:301-656-9690
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA101042795207W00000X
DCMD30373207W00000X
MDD0052312207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010041813Medicaid
VA010041813Medicaid
VA010041813Medicaid