Provider Demographics
NPI:1043359292
Name:MITTMAN, DEAN L (MD)
Entity type:Individual
Prefix:DR
First Name:DEAN
Middle Name:L
Last Name:MITTMAN
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 1:1515 SAVANNAH RD
Mailing Address - Street 2:
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958-1675
Mailing Address - Country:US
Mailing Address - Phone:302-645-3499
Mailing Address - Fax:302-644-4830
Practice Address - Street 1:18947 JOHN J WILLIAMS HWY UNIT 201
Practice Address - Street 2:
Practice Address - City:REHOBOTH BEACH
Practice Address - State:DE
Practice Address - Zip Code:19971-4476
Practice Address - Country:US
Practice Address - Phone:302-645-4801
Practice Address - Fax:888-987-4173
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2025-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO111705207N00000X
DEC1-0028187207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO110426OtherMO MEDICARE
AR81287OtherARK BLUE SHIELD
MO208573014Medicaid
AR142569001Medicaid
AR81287OtherARK BLUE SHIELD
MO009013268Medicare PIN