Provider Demographics
NPI:1801241914
Name:MIMIER, MITCHELL (DO)
Entity type:Individual
Prefix:
First Name:MITCHELL
Middle Name:
Last Name:MIMIER
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 GEESE LNDG
Mailing Address - Street 2:
Mailing Address - City:GLEN ALLEN
Mailing Address - State:VA
Mailing Address - Zip Code:23060-5885
Mailing Address - Country:US
Mailing Address - Phone:704-798-9878
Mailing Address - Fax:
Practice Address - Street 1:11015 WARWICK BLVD
Practice Address - Street 2:
Practice Address - City:NEWPORT NEWS
Practice Address - State:VA
Practice Address - Zip Code:23601-3225
Practice Address - Country:US
Practice Address - Phone:757-591-7291
Practice Address - Fax:757-595-9518
Is Sole Proprietor?:No
Enumeration Date:2016-04-26
Last Update Date:2021-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC218045207Q00000X
VA0102206006207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine