Provider Demographics
NPI:1952448821
Name:MITCHELL, DONALD G (PA)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:G
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2814 CHERRY TREE WAY
Mailing Address - Street 2:
Mailing Address - City:NEW WINDSOR
Mailing Address - State:NY
Mailing Address - Zip Code:12553-4928
Mailing Address - Country:US
Mailing Address - Phone:845-321-5817
Mailing Address - Fax:
Practice Address - Street 1:HARLEM HOSPITAL CENTER
Practice Address - Street 2:506 LENOX AVE
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10037
Practice Address - Country:US
Practice Address - Phone:212-862-0140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0036271363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY444315Medicaid