Provider Demographics
NPI:1104323930
Name:MITCHELL, JONATHAN ANTHONY (MD)
Entity type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:ANTHONY
Last Name:MITCHELL
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6201 GREENLEIGH AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-2004
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:410-500-4266
Practice Address - Street 1:2041 GEORIGA AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20059
Practice Address - Country:US
Practice Address - Phone:202-865-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2025-03-19
Deactivation Date:2018-11-16
Deactivation Code:
Reactivation Date:2018-11-26
Provider Licenses
StateLicense IDTaxonomies
MDD0103099208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery