Provider Demographics
NPI:1205015054
Name:DAVID A. MISHKIN MD PA
Entity Type:Organization
Organization Name:DAVID A. MISHKIN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:MISHKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:410-484-5686
Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 350
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6391
Mailing Address - Country:US
Mailing Address - Phone:410-484-5686
Mailing Address - Fax:410-484-6472
Practice Address - Street 1:1838 GREENE TREE RD
Practice Address - Street 2:SUITE 350
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-6391
Practice Address - Country:US
Practice Address - Phone:410-484-5686
Practice Address - Fax:410-484-6472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-29
Last Update Date:2007-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD24266207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDK720Medicare PIN