Provider Demographics
NPI:1952407850
Name:MITCHELL, JOYCE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JOYCE
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 W 4TH ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:OH
Mailing Address - Zip Code:44906-1770
Mailing Address - Country:US
Mailing Address - Phone:419-526-8955
Mailing Address - Fax:419-526-8114
Practice Address - Street 1:1750 W 4TH ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:OH
Practice Address - Zip Code:44906-1770
Practice Address - Country:US
Practice Address - Phone:419-526-8955
Practice Address - Fax:419-526-8114
Is Sole Proprietor?:No
Enumeration Date:2006-09-16
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJMA78375207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0060399Medicaid
C85590Medicare UPIN
NJ088561Medicare ID - Type Unspecified