Basic Information
| Provider Information | |||||||||
| NPI: | 1619922259 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | FOOT & ANKLE ASSOCIATES DRS LISS & MIRKIN PA | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KENSINGTON SURGERY CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 10901 CONNECTICUT AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019492000 | ||||||||
| FaxNumber: | 3019492002 | ||||||||
| Practice Location | |||||||||
| Address1: | 10901 CONNECTICUT AVE | ||||||||
| Address2: | STE 200 | ||||||||
| City: | KENSINGTON | ||||||||
| State: | MD | ||||||||
| PostalCode: | 20895 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3019492000 | ||||||||
| FaxNumber: | 3019492002 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/23/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MIRKIN | ||||||||
| AuthorizedOfficialFirstName: | GENE | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DOCTOR | ||||||||
| AuthorizedOfficialTelephone: | 3019692000 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DPM | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 213ES0103X | A1081 | MD | Y | 193400000X SINGLE SPECIALTY GROUP | Podiatric Medicine & Surgery Service Providers | Podiatrist | Foot & Ankle Surgery |
No ID Information.