Provider Demographics
NPI:1730177692
Name:BIRNS, GLOGER AND WITTEN, MD PC
Entity type:Organization
Organization Name:BIRNS, GLOGER AND WITTEN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:BIRNS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-251-0015
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0024994174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC422621Medicare PIN
MD133161Medicare PIN