Provider Demographics
NPI:1952480048
Name:MITCHELL, MARIA (DO)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1429 E FIRE TOWER RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:GREENVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:27858-5730
Mailing Address - Country:US
Mailing Address - Phone:252-364-2802
Mailing Address - Fax:252-207-0709
Practice Address - Street 1:1429 E FIRE TOWER RD
Practice Address - Street 2:SUITE 104
Practice Address - City:GREENVILLE
Practice Address - State:NC
Practice Address - Zip Code:27858-5730
Practice Address - Country:US
Practice Address - Phone:252-364-2802
Practice Address - Fax:252-207-0709
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2005-00543207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC5907465Medicaid
NC5907465Medicaid