Individual
DR. MITCHELL LEE SHELLMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5189
(215) 707-2000
Mailing address
3401 N BROAD ST, PHILADELPHIA, PA 19140-5189
(215) 707-2000
Taxonomy
Speciality
Code
Description
License number
State
208D00000X
General Practice Physician
Primary
M-17432
ID
390200000X
Student in an Organized Health Care Education/Training Program
MT226019
PA
390200000X
Student in an Organized Health Care Education/Training Program
—
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
208D00000X
—
ID
05
—
MT226019
—
PA
Enumeration date
03/22/2021
Last updated
09/22/2023
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