Active NPI
Marcia Marie Mitchell, M.D.
- Internal Medicine Physician
- Sandy, UT
National Provider Identifier
1780193763
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Internal Medicine Physician
- License
- 149372-1205
- Practice address
- 4 Longwood Lane
Sandy, UT 84092 - Phone
- (801) 501-9734
- NPI assigned
- Sep 22, 2017
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Internal Medicine Physician | 207R00000X | 149372-1205 | UT | Primary |
Addresses
Primary practice location
4 Longwood Lane
Sandy, UT 84092
Mailing address
PO Box 711640
Salt Lake City, UT 84171
Phone (801) 501-9734
Other names 1
- Ms. Marcia Marie Keller
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 149372-1205 | UT | MD | Internal Medicine Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1506038400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1506038400000",
"number": "1780193763",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 711640",
"city": "SALT LAKE CITY",
"state": "UT",
"postal_code": "84171",
"telephone_number": "801-501-9734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4 LONGWOOD LANE",
"city": "SANDY",
"state": "UT",
"postal_code": "84092",
"telephone_number": "801-501-9734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MITCHELL",
"first_name": "MARCIA",
"middle_name": "MARIE",
"name_prefix": "Mrs.",
"credential": "M.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-09-22",
"last_updated": "2017-09-22",
"status": "A"
},
"taxonomies": [
{
"code": "207R00000X",
"taxonomy_group": "",
"desc": "Internal Medicine",
"state": "UT",
"license": "149372-1205",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "MARCIA",
"last_name": "KELLER",
"middle_name": "MARIE",
"prefix": "MS.",
"credential": "M.D",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Sandy, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.