Provider Demographics
NPI:1700800703
Name:MITCHELL, CHARLES HOPKINS (MD)
Entity type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:HOPKINS
Last Name:MITCHELL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:207 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEWMARKET
Mailing Address - State:NH
Mailing Address - Zip Code:03857-1843
Mailing Address - Country:US
Mailing Address - Phone:603-292-7292
Mailing Address - Fax:
Practice Address - Street 1:50 MONUMENT SQ
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-4039
Practice Address - Country:US
Practice Address - Phone:207-874-1055
Practice Address - Fax:207-774-5901
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2021-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME0129552084P0800X
NHT-10302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213910000Medicaid
NHPENDINGMedicaid