Individual provider Active NPI

Drew Christian Mitchell, MD

  • Pediatric Dermatology Physician
  • Philadelphia, PA
National Provider Identifier
1114547932
Registry record updated Jun 3, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Dermatology PhysicianTaxonomy code 207NP0225X
License
MT232022 Issued in PA
Practice address
3401 Civic Center Blvd
Division of Pediatric Dermatology
Philadelphia, PA 19104-0001
Phone
(215) 590-2169
NPI assigned
Apr 22, 2020
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 3, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X 284580 MA
Student in an Organized Health Care Education/Training Program 390200000X NM
Student in an Organized Health Care Education/Training Program 390200000X
Pediatric Dermatology Physician 207NP0225X MT232022 PA Primary

Addresses

Primary practice location

3401 Civic Center Blvd
Division of Pediatric Dermatology
Philadelphia, PA 19104-0001

Mailing address

3401 Civic Center Blvd
Division of Pediatric Dermatology
Philadelphia, PA 19104-0001
Phone (215) 590-2169

Other practice location 1

601 Elmwood Ave
Medical Director's Office
Rochester, NY 14642-0001
Phone (585) 275-4786

Other practice location 2

1 University Of New Mexico Msc07 4240
Albuquerque, NM 87131-0001
Phone (505) 272-6000

Other practice location 3

330 Brookline Ave
Boston, MA 02215-5491
Phone (617) 667-7000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200824002219 MA Order and Referring Only - Internal MedicinePractitioner - Internal Medicine 9436576352

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MT232022PAMDPediatric Dermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Childrens Health Care Associates of New Jersey PC Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1587513600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717372800000",
    "number": "1114547932",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "DIVISION OF PEDIATRIC DERMATOLOGY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191040001",
            "telephone_number": "215-590-2169"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 CIVIC CENTER BLVD",
            "address_2": "DIVISION OF PEDIATRIC DERMATOLOGY",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191040001",
            "telephone_number": "215-590-2169"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "601 Elmwood Ave",
            "address_2": "Medical Director's Office",
            "address_purpose": "LOCATION",
            "city": "Rochester",
            "state": "NY",
            "postal_code": "146420001",
            "country_code": "US",
            "telephone_number": "585-275-4786",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1 University Of New Mexico Msc07 4240",
            "address_purpose": "LOCATION",
            "city": "Albuquerque",
            "state": "NM",
            "postal_code": "871310001",
            "country_code": "US",
            "telephone_number": "505-272-6000",
            "fax_number": "505-272-6003",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "330 Brookline Ave",
            "address_purpose": "LOCATION",
            "city": "Boston",
            "state": "MA",
            "postal_code": "022155491",
            "country_code": "US",
            "telephone_number": "617-667-7000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MITCHELL",
        "first_name": "DREW",
        "middle_name": "CHRISTIAN",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-04-22",
        "last_updated": "2024-06-03",
        "certification_date": "2024-06-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "MA",
            "license": "284580",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "NM",
            "license": null,
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207NP0225X",
            "taxonomy_group": "",
            "desc": "Dermatology, Pediatric Dermatology",
            "state": "PA",
            "license": "MT232022",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Philadelphia, PA

Sources for this page

Verify at the official NPI Registry.