Provider Demographics
NPI:1811996044
Name:MITCHELL, REGINA MARIE (MD)
Entity type:Individual
Prefix:DR
First Name:REGINA
Middle Name:MARIE
Last Name:MITCHELL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:REGINA
Other - Middle Name:MARIE
Other - Last Name:LA BARBERA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3001 S HANOVER ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21225
Mailing Address - Country:US
Mailing Address - Phone:410-350-8213
Mailing Address - Fax:
Practice Address - Street 1:3001 S HANOVER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21225
Practice Address - Country:US
Practice Address - Phone:410-350-8213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-07-19
Last Update Date:2017-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101840507207V00000X
MDD0069773207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00W071R01Medicare PIN
H21854Medicare UPIN
DC143490ZAK4Medicare PIN