Provider Demographics
NPI:1124120811
Name:MITCHELL, CHERYL MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:128 ROUTE 70 STE 16B
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-2371
Mailing Address - Country:US
Mailing Address - Phone:609-654-6940
Mailing Address - Fax:609-654-5725
Practice Address - Street 1:128 ROUTE 70 STE 16B
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-2371
Practice Address - Country:US
Practice Address - Phone:609-654-6940
Practice Address - Fax:609-654-5725
Is Sole Proprietor?:No
Enumeration Date:2006-09-02
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA05315800207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0042027000OtherAMERIHEALTH NJ
NJ0042027000OtherKEYSTONE HEALTH PLAN EAST
NJ10605OtherSPECTERA VISION PLAN
NJ1138894OtherHORIZON NJ HEALTH
NJ223672457OtherHORIZON BLUE CROSS/BS
NJ223672457OtherUSFHP ST VINCENTS MEDICAL
NJ223672457OtherQUALCARE
NJ5478105OtherAETNA US HEALTH CARE
NJ180612OtherUNITED HEALTHCARE
NJ000340005OtherHIGHMARK BLEU SHIELD
NJ000537359OtherHIGHMARK BLUE SHIELD
NJ1K5324OtherHEALTH NET
NJ24329OtherUNIVERSITY HEALTH PLAN
NJ40248OtherCOLE VISION
NJC400005OtherAMERIHEALTH ADMINISTRATOR
NJ05278OtherDAVIS VISION
NJ10605OtherCARPENTERS
NJ8103704Medicaid
NJF06824Medicare UPIN
NJ537359Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER