Provider Demographics
NPI:1982881264
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:301-949-2000
Mailing Address - Fax:301-949-2002
Practice Address - Street 1:2415 MUSGROVE RD
Practice Address - Street 2:SUITE 103
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-5200
Practice Address - Country:US
Practice Address - Phone:301-384-6500
Practice Address - Fax:301-384-6670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD061368101Medicaid
MD061368101Medicaid
DC613747M38Medicare PIN
DC010074M38Medicare PIN
DC884138Medicare PIN
GADF3813Medicare PIN
DCG02622Medicare PIN