Basic Information
| Provider Information | |||||||||
| NPI: | 1013270487 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MITCHELL | ||||||||
| FirstName: | LYDIA | ||||||||
| MiddleName: | DARLUD | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3643 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194705345 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3643 N ROXBORO ST | ||||||||
| Address2: | |||||||||
| City: | DURHAM | ||||||||
| State: | NC | ||||||||
| PostalCode: | 277042702 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9194705345 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2012 | ||||||||
| LastUpdateDate: | 12/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207P00000X | 2018-00689 | NC | Y | Allopathic & Osteopathic Physicians | Emergency Medicine |
No ID Information.