Provider Demographics
NPI:1134144322
Name:MITCHELL, HOPE TERECIA (MD)
Entity type:Individual
Prefix:DR
First Name:HOPE
Middle Name:TERECIA
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:815 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-5255
Mailing Address - Country:US
Mailing Address - Phone:419-872-4673
Mailing Address - Fax:419-873-8329
Practice Address - Street 1:815 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-5255
Practice Address - Country:US
Practice Address - Phone:419-871-3737
Practice Address - Fax:419-873-8329
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-12
Last Update Date:2022-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35073958M207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHG68028Medicare UPIN
OH9344881Medicare ID - Type UnspecifiedPROVIDER NUMBER