Provider Demographics
NPI:1477627610
Name:SISKIND, MARK LEWIS (DC)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:LEWIS
Last Name:SISKIND
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3808 EASTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-4221
Mailing Address - Country:US
Mailing Address - Phone:443-708-3201
Mailing Address - Fax:443-708-3343
Practice Address - Street 1:3808 EASTERN AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224-4221
Practice Address - Country:US
Practice Address - Phone:443-708-3201
Practice Address - Fax:443-708-3343
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2011-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01319111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor