Provider Demographics
NPI:1104944990
Name:MARK A GOREN P C
Entity type:Organization
Organization Name:MARK A GOREN P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOREN
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:301-949-0440
Mailing Address - Street 1:3706 PERRY AVENUE
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2118
Mailing Address - Country:US
Mailing Address - Phone:301-949-0440
Mailing Address - Fax:301-949-2913
Practice Address - Street 1:3706 PERRY AVENUE
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-2118
Practice Address - Country:US
Practice Address - Phone:301-949-0440
Practice Address - Fax:301-949-2913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-27
Last Update Date:2008-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01123111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC769009Medicare PIN