Provider Demographics
NPI:1891836862
Name:KHO, MITCHELL ROBERT CHIONG (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL ROBERT
Middle Name:CHIONG
Last Name:KHO
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:208 FLOURTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1209
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:600 EVERGREEN DR
Practice Address - Street 2:SUITE 630
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1053
Practice Address - Country:US
Practice Address - Phone:610-358-2250
Practice Address - Fax:610-358-2251
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-10
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD-065625-L2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAH58510Medicare UPIN