Provider Demographics
NPI:1811977465
Name:MIRKIN, GABE (MD)
Entity type:Individual
Prefix:DR
First Name:GABE
Middle Name:
Last Name:MIRKIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:GABRIEL
Other - Middle Name:BARON
Other - Last Name:MIRKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1455 BRIER CREEK CIR
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-4101
Mailing Address - Country:US
Mailing Address - Phone:352-350-6216
Mailing Address - Fax:352-350-6216
Practice Address - Street 1:10901 CONNECTICUT AVENUE
Practice Address - Street 2:
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
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2015-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0013921207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
G01217Medicare ID - Type Unspecified
C61718Medicare UPIN