Provider Demographics
NPI:1487612800
Name:MITCHELL, BETTY MARGARET (MD)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:MARGARET
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 1:5195 HAMPSTED VILLAGE CENTER WAY
Mailing Address - Street 2:SUITE 256
Mailing Address - City:NEW ALBANY
Mailing Address - State:OH
Mailing Address - Zip Code:43054-8331
Mailing Address - Country:US
Mailing Address - Phone:866-748-5432
Mailing Address - Fax:614-283-9639
Practice Address - Street 1:420 N JAMES RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43219-1834
Practice Address - Country:US
Practice Address - Phone:614-257-2500
Practice Address - Fax:614-257-5386
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0062975207P00000X, 207R00000X
KY46726207P00000X
OH35075253M207R00000X
OH35075253207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2151513Medicaid
OHH001891Medicare PIN
G94357Medicare UPIN
OH4034057Medicare PIN