Provider Demographics
NPI:1447249735
Name:SPAHN, MITCHELL WILLIAM (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:WILLIAM
Last Name:SPAHN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:980-367-4363
Mailing Address - Fax:704-316-2558
Practice Address - Street 1:1901 E 5TH ST
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28204-2429
Practice Address - Country:US
Practice Address - Phone:980-367-4363
Practice Address - Fax:704-384-1644
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.060262S207V00000X
NC2020-04761207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000302267OtherANTHEM
OH0821089Medicaid
OHSP0699713Medicare ID - Type Unspecified
OH0821089Medicaid