Provider Demographics
NPI:1982692828
Name:BIRNS, MARK THEODORE (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:THEODORE
Last Name:BIRNS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9711 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 308
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3323
Mailing Address - Country:US
Mailing Address - Phone:301-251-1244
Mailing Address - Fax:301-340-9360
Practice Address - Street 1:9711 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 308
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3323
Practice Address - Country:US
Practice Address - Phone:301-251-0015
Practice Address - Fax:301-340-9360
Is Sole Proprietor?:No
Enumeration Date:2005-10-13
Last Update Date:2013-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024994207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD322021400Medicaid
MDB70889Medicare UPIN
MD133215ZAOHMedicare PIN
MD322021400Medicaid