NPIMap

Individual provider Active NPI

Misha Matongo Mutizwa, M.D.

  • Dermatology Physician
  • Danville, PA
National Provider Identifier
1154559375
Registry record updated Aug 27, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Dermatology PhysicianTaxonomy code 207N00000X
License
MD452484 Issued in PA
Practice address
16 Woodbine Lane
Danville, PA 17822
Phone
(570) 271-8050
Fax
(570) 271-5940
NPI assigned
Jun 25, 2009
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 27, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Dermatology Physician 207N00000X A126572 CA
Dermatology Physician 207N00000X MD452484 PA Primary

Addresses

Primary practice location

16 Woodbine Lane
Danville, PA 17822

Mailing address

100 N Academy Ave
Danville, PA 17822-4903
Phone (570) 271-6144

Other practice location 1

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3376

Other practice location 2

3401 N Broad St
Philadelphia, PA 19140-5103
Phone (215) 707-3376

Electronic endpoints 1

TypeEndpointUseAffiliation
Direct Messaging Address mmutizwa192025@direct.geisinger.edu Direct

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20141001001507 PA Practitioner - Dermatology 8123257870 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Dermatology
Education
Duke University School of Medicine, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Geisinger ClinicGroup PAC ID 5395657001, 3,432 clinicians

Practice addresses (Care Compare)

2407 Reichart Rd
Bloomsburg, PA 17815-8969
Phone (570) 784-8303

Hospital & facility affiliations

  • Geisinger Medical Center Hospital, Danville, PA, CCN 390006

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of skin lesions480
Removal or shaving of skin growth1-10
Skin biopsy319

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
126572CAMDClinical Social Worker
A126572CAMDDermatology Physician
MD452484PAMDDermatology Physician

Practice roles

OrganizationSpecialtyStatusNew patients
Geisinger Clinic Current Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Jul 1, 2020 Accepting new patients
Geisinger Clinic CurrentSince Aug 19, 2019 Accepting new patients
Geisinger-HM Joint Venture, LLC CurrentSince Jul 1, 2020 Accepting new patients
Geisinger-HM Joint Venture, LLC Current Accepting new patients
Geisinger Clinic Past Accepting new patients
Zitelli & Brodland PC PastSince Jun 1, 2026 Accepting new patients

Locations

2407 Reichart Rd
Bloomsburg, PA 17815
Phone (570) 784-6320

16 Woodbine Ln
Danville, PA 17821
Phone (570) 271-6531

100 N Academy Ave
Danville, PA 17822

1525 N Church St
Hazle Township, PA 18202
Phone (570) 454-5222

955 Bellefonte Ave
Lock Haven, PA 17745
Phone (570) 748-7714

10 Choate Cir
Montoursville, PA 17754
Phone (570) 368-5566

Interoperability endpoints

  • Direct secure messaging: mmutizwa192025@direct.geisinger.edu

Organizations & group practices 7

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.

Hospital & facility affiliations 26

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

View all 26

NPI Registry JSON

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

{
    "created_epoch": "1245888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1598486400000",
    "number": "1154559375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "100 N ACADEMY AVE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "178224903",
            "telephone_number": "570-271-6144",
            "fax_number": "570-271-6578"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 WOODBINE LANE",
            "city": "DANVILLE",
            "state": "PA",
            "postal_code": "17822",
            "telephone_number": "570-271-8050",
            "fax_number": "570-271-5940"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3401 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-3376",
            "fax_number": "215-707-9510",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3401 N Broad St",
            "address_purpose": "LOCATION",
            "city": "Philadelphia",
            "state": "PA",
            "postal_code": "191405103",
            "country_code": "US",
            "telephone_number": "215-707-3376",
            "fax_number": "215-707-9510",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MUTIZWA",
        "first_name": "MISHA",
        "middle_name": "MATONGO",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-06-25",
        "last_updated": "2020-08-27",
        "certification_date": "2020-08-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "CA",
            "license": "A126572",
            "primary": false
        },
        {
            "code": "207N00000X",
            "taxonomy_group": "",
            "desc": "Dermatology",
            "state": "PA",
            "license": "MD452484",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mmutizwa192025@direct.geisinger.edu",
            "affiliation": "N",
            "use": "DIRECT",
            "useDescription": "Direct",
            "address_1": "16 Woodbine Lane",
            "city": "Danville",
            "state": "PA",
            "country_code": "US",
            "postal_code": "17822",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

Other providers in Danville, PA

Sources for this page

Verify at the official NPI Registry.