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General NPI Number Information
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NPI Number | 1104944990
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Entity Type | Organization
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Legal Business Name | MARK A GOREN P C
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Dates
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Enumeration Date | 03/27/2007
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Last Update Date | 05/20/2008
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Provider Practice Location Address
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Address Line | 3706 PERRY AVENUE
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City | KENSINGTON
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State | MD
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Zip | 20895-2118
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Country | US
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Telephone | 301-949-0440
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Fax | 301-949-2913
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Provider Business Mailing Address
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Address Line | 3706 PERRY AVENUE
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City | KENSINGTON
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State | MD
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Zip | 20895-2118
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Country | US
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Telephone | 301-949-0440
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Fax | 301-949-2913
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MARK ALLEN GOREN
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Credential | D.C.
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Telephone | 301-949-0440
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | 01123
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License Number State | MD
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