Provider Demographics
NPI:1700072196
Name:THOMAS MITCHELL MD PC
Entity type:Organization
Organization Name:THOMAS MITCHELL MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:FORDE
Authorized Official - Last Name:RYNNE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:781-826-5429
Mailing Address - Street 1:PO BOX 2315
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-8315
Mailing Address - Country:US
Mailing Address - Phone:781-826-5429
Mailing Address - Fax:
Practice Address - Street 1:55 FOGG RD
Practice Address - Street 2:
Practice Address - City:SOUTH WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02190-2432
Practice Address - Country:US
Practice Address - Phone:781-826-5429
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA76490207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3168760Medicaid
MA076490OtherTUFTS
MAJ17798OtherBLUE CROSS
MA172423OtherHARVARD PILGRIM
MA3168760Medicaid
MAG51923Medicare UPIN