Provider Demographics
NPI:1912972837
Name:MITCHELL, BRENDA ELLIS (MD)
Entity Type:Individual
Prefix:DR
First Name:BRENDA
Middle Name:ELLIS
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:850 SLIGO AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4703
Mailing Address - Country:US
Mailing Address - Phone:301-495-9090
Mailing Address - Fax:301-495-7783
Practice Address - Street 1:850 SLIGO AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4703
Practice Address - Country:US
Practice Address - Phone:301-495-9090
Practice Address - Fax:301-495-7783
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0053523207Q00000X, 2083P0901X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Not Answered2083P0901XAllopathic & Osteopathic PhysiciansPreventive MedicinePublic Health & General Preventive Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01763B01Medicare ID - Type Unspecified
G51573Medicare UPIN