Provider Demographics
NPI:1144313321
Name:MITCHELL, SANDRA ELAINE (MD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:ELAINE
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 1:1317 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27401-1033
Mailing Address - Country:US
Mailing Address - Phone:336-274-9617
Mailing Address - Fax:336-482-2177
Practice Address - Street 1:1317 N ELM STREET
Practice Address - Street 2:SUITE 1B
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-1023
Practice Address - Country:US
Practice Address - Phone:336-274-9617
Practice Address - Fax:336-482-2177
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2012-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC016082085R0001X
NC2002016092085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA05881137Medicaid
NC133M4OtherBLUECROSS/BLUESHIELD
3500300OtherUNITED HEALTHCARE
C3033OtherMEDCOST
E211OtherPARTNERS NATIONAL HEALTH
7329931OtherCIGNA HEALTHCARE
NC89133M4Medicaid
E14982Medicare UPIN
3500300OtherUNITED HEALTHCARE
2010966Medicare ID - Type Unspecified