Mark J. Mittenthal, MD

Primary specialty

Vascular Surgery PhysicianTaxonomy code 2086S0129X

License

017864 Issued in GA

Practice address

5669 Peachtree Dunwoody Rd
Suite 100
Atlanta, GA 30342-1786

Phone

(404) 256-0404

Fax

(404) 847-0423

NPI assigned

Feb 15, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: mmittenthal47737@direct.emory.org

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.

• Vascular Institute of Georgia, PC

  dba Vascular Insitute of Georiga, PC

  • Vascular Surgery Physician
  • Atlanta, GA
  • NPI 1932167269
  NPD (past) Authorized official
• Northside Radiology Associates LLC

  • Diagnostic Radiology Physician
  • Atlanta, GA
  • NPI 1013960657
  NPD (past)
• St. Joseph's Hospital

  • Critical Access Hospital
  • Atlanta, GA
  • NPI 1316158793
  NPD (past)

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

{
    "created_epoch": "1139961600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1314057600000",
    "number": "1598739559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1838 AMERICAN WAY",
            "city": "LAWRENCEVILLE",
            "state": "GA",
            "postal_code": "300436611",
            "telephone_number": "770-995-7622",
            "fax_number": "770-995-7854"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5669 PEACHTREE DUNWOODY RD",
            "address_2": "SUITE 100",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303421786",
            "telephone_number": "404-256-0404",
            "fax_number": "404-847-0423"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MITTENTHAL",
        "first_name": "MARK",
        "middle_name": "J.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-15",
        "last_updated": "2011-08-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2086S0129X",
            "taxonomy_group": "",
            "desc": "Surgery, Vascular Surgery",
            "state": "GA",
            "license": "017864",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "000206005",
            "state": "GA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Aditi Mitra, PHD, MA, MFT
• Kiren Mitruka, M.D.
• Pardeep Kumar Mittal, M.D
• Sneha Mittal
• Daniel Robert Mitteer, PHD
• Nicole Mitter, CNIM
• Rachel Renee Mitts, MCMSC, PA-C
• Jeremy Evan Mix
• Gloria Mixon, OTD, OTR/L
• Shelly Mixson

• Vascular Surgery Physician in Atlanta, GA
• Providers in Atlanta, GA by specialty
• Vascular Surgery Physician in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 23, 2011; 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.