DWIGHT MITCHELL SELF II MD
NPI 1578192175
Student in an Organized Health Care Education/Training Program in Philadelphia, PA

Q: What is the provider's specialty?

The provider's specialty is Student in an Organized Health Care Education/Training Program with taxonomy code 390200000X.

Active since April 06, 2020PECOS Enrolled

909 WALNUT ST FL 2, PHILADELPHIA, PA 19107(215) 955-7000(215) 503-7038 Get Directions Write a Review

NPPES record last updated: April 6, 2020. Verified against the NPPES registry weekly; last sync: July 19, 2026.

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About Dwight Mitchell Self Ii Md NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DWIGHT MITCHELL SELF II MD (NPI 1578192175) is an individual student in an organized health care education/training program in Philadelphia, Pennsylvania and active in the NPI registry since April 2020. He is enrolled in Medicare PECOS.

NPPES Registry Identity

NPI1578192175

Entity TypeIndividualMale

Primary Taxonomy390200000X

Provider Legal NameDWIGHT MITCHELL SELF IICredential: MD

Location Address909 WALNUT ST FL 2Philadelphia, PA 19107-5211

Mailing Address909 Walnut St Fl 3Philadelphia, PA 19107-5211 · (215) 503-7008 · Fax (215) 503-2452

Phone(215) 955-7000

Fax(215) 503-7038

Sole ProprietorNo

Enumeration DateApril 6, 2020

NPPES CertifiedApril 6, 2020

✔ NPI 1578192175 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyStudent in an Organized Health Care Education/Training ProgramStudent, Health Care

Taxonomy Code390200000X

Definition

An individual who is enrolled in an organized health care education/training program leading to a degree, certification, registration, and/or licensure to provide health care.

909 WALNUT ST FL 2, Philadelphia, PA 19107

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Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Dwight Mitchell Self Ii Md is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.