Provider Demographics
NPI:1427044114
Name:MITCHELL, JOHN MARVIN (MD)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:MARVIN
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 MESSIMER DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:OH
Mailing Address - Zip Code:43055-1842
Mailing Address - Country:US
Mailing Address - Phone:220-564-1880
Mailing Address - Fax:220-564-1881
Practice Address - Street 1:30 MESSIMER DR
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:OH
Practice Address - Zip Code:43055-1842
Practice Address - Country:US
Practice Address - Phone:220-564-1880
Practice Address - Fax:220-564-1881
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.084820208600000X
PAMD417322208600000X
OH35084820208600000X
WV21706208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2541566Medicaid
WV3810001266Medicaid
I15018Medicare UPIN
WV4141404Medicare PIN
OH4141405Medicare PIN