Provider Demographics
NPI:1447221684
Name:DRS. LISS & MIRKIN, P.A. T/A FOOT & ANKLE ASSOCIATES
Entity Type:Organization
Organization Name:DRS. LISS & MIRKIN, P.A. T/A FOOT & ANKLE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:MIRKIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-949-2000
Mailing Address - Street 1:10901 CONNECTICUT AVE
Mailing Address - Street 2:#200
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1645
Mailing Address - Country:US
Mailing Address - Phone:301-949-2000
Mailing Address - Fax:301-949-2002
Practice Address - Street 1:10901 CONNECTICUT AVENUE
Practice Address - Street 2:#200
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895
Practice Address - Country:US
Practice Address - Phone:301-949-2000
Practice Address - Fax:301-949-2002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2008-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA1081261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD21C0001081OtherHIXA
227957Medicare UPIN
309467Medicare ID - Type Unspecified