Individual
MARK MITTELMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
262 LEROY GEORGE DR, STE X, CLYDE, NC 28721-7430
(828) 452-8346
Mailing address
5220 GREENS DAIRY RD, RALEIGH, NC 27616-4612
(919) 256-3576
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
200300668
NC
2085R0202X
Diagnostic Radiology Physician
200300668
NC
2085R0204X
Vascular & Interventional Radiology Physician
Primary
200300668
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
89134MR
—
NC
Enumeration date
07/07/2005
Last updated
03/07/2023
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