Provider Demographics
NPI:1679585293
Name:BLOCK, MITCHELL HOWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MITCHELL
Middle Name:HOWARD
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 7068
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23707-0068
Mailing Address - Country:US
Mailing Address - Phone:757-686-3508
Mailing Address - Fax:757-686-0541
Practice Address - Street 1:1168 FIRST COLONIAL RD
Practice Address - Street 2:STE 201
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23454-2444
Practice Address - Country:US
Practice Address - Phone:757-481-1113
Practice Address - Fax:757-496-3822
Is Sole Proprietor?:No
Enumeration Date:2006-08-12
Last Update Date:2012-11-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
390200000X
VA0101252048207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No208000000XAllopathic & Osteopathic PhysiciansPediatrics