Provider Demographics
NPI:1215949193
Name:MITCHELL, JOSEPH DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:DAVID
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:2110 GALLOWS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:VIENNA
Mailing Address - State:VA
Mailing Address - Zip Code:22182-3962
Mailing Address - Country:US
Mailing Address - Phone:703-790-1304
Mailing Address - Fax:703-821-8922
Practice Address - Street 1:2110 GALLOWS RD
Practice Address - Street 2:SUITE D
Practice Address - City:VIENNA
Practice Address - State:VA
Practice Address - Zip Code:22182-3962
Practice Address - Country:US
Practice Address - Phone:703-790-1304
Practice Address - Fax:703-821-8922
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2013-02-18
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
VA01010394232084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA67087OtherANTHEM
VAD09659Medicare UPIN
VA67087OtherANTHEM