Mitchell S Mednick, DO

Primary specialty

Neuromusculoskeletal Medicine & OMM PhysicianTaxonomy code 204D00000X

License

OS006362E Issued in PA

Practice address

1514 E Moyamensing Ave
Philadelphia, PA 19147

Phone

(615) 345-5400

NPI assigned

Apr 18, 2007

Last updated

Aug 13, 2018By the provider in NPPES

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

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

{
    "created_epoch": "1176854400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1534118400000",
    "number": "1164648846",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3 MARYLAND FARMS STE 200",
            "city": "BRENTWOOD",
            "state": "TN",
            "postal_code": "370275005",
            "telephone_number": "615-345-5400",
            "fax_number": "615-345-5405"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1514 E MOYAMENSING AVE",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "19147",
            "telephone_number": "615-345-5400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MEDNICK",
        "first_name": "MITCHELL",
        "middle_name": "S",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-04-18",
        "last_updated": "2018-08-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "204D00000X",
            "taxonomy_group": "",
            "desc": "Neuromusculoskeletal Medicine & OMM",
            "state": "PA",
            "license": "OS006362E",
            "primary": true
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "PA",
            "license": "0S006362E",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neuromusculoskeletal Medicine & OMM Physician in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Neuromusculoskeletal Medicine & OMM Physician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.