Provider Demographics
NPI:1699724013
Name:MITCHELL, DAVID M (MD PHD)
Entity type:Individual
Prefix:DR
First Name:DAVID
Middle Name:M
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:58 CARROLL ST
Mailing Address - Street 2:ROOM 2037
Mailing Address - City:LEBANON
Mailing Address - State:VA
Mailing Address - Zip Code:24266
Mailing Address - Country:US
Mailing Address - Phone:276-883-8062
Mailing Address - Fax:276-883-8064
Practice Address - Street 1:58 CARROLL ST
Practice Address - Street 2:ROOM 2037
Practice Address - City:LEBANON
Practice Address - State:VA
Practice Address - Zip Code:24266
Practice Address - Country:US
Practice Address - Phone:276-883-8062
Practice Address - Fax:276-883-8064
Is Sole Proprietor?:No
Enumeration Date:2006-05-10
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101260654207R00000X
OH35-086262208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208M00000XAllopathic & Osteopathic PhysiciansHospitalist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1699724013Medicaid
TNQ026153Medicaid
TNQ026153Medicaid