Provider Demographics
NPI:1588858658
Name:MIRKIN MEDICAL CONSULTANTS
Entity Type:Organization
Organization Name:MIRKIN MEDICAL CONSULTANTS
Other - Org Name:ALLERGY & IMMUNOLOGY ASSOC.
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GABE
Authorized Official - Middle Name:
Authorized Official - Last Name:MIRKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-942-7900
Mailing Address - Street 1:10901 CONNECTICUT AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-1645
Mailing Address - Country:US
Mailing Address - Phone:301-942-7900
Mailing Address - Fax:301-942-9837
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
Practice Address - Country:US
Practice Address - Phone:301-942-7900
Practice Address - Fax:301-942-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013921174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG01217OtherMEDICARE GRP NO
MD=========OtherTAX ID NO