Provider Demographics
NPI:1205941192
Name:MIRKIN FOOT ASSOCIATES PA
Entity type:Organization
Organization Name:MIRKIN FOOT ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
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 1:2415 MUSGROVE RD
Mailing Address - Street 2:SUITE 103
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-5200
Mailing Address - Country:US
Mailing Address - Phone:301-384-6500
Mailing Address - Fax:301-384-6670
Practice Address - Street 1:10901 CONNECTICUT AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-1645
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:2006-08-20
Last Update Date:2011-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD061368100Medicaid
GADF3813Medicare PIN
DCG02622Medicare PIN
MD061368100Medicaid