Healthcare Provider Details

I. General information

NPI: 1588272397
Provider Name (Legal Business Name): GERSON ZATEZALO SKIN & FACE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/17/2020
Last Update Date: 09/23/2020
Certification Date: 09/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4910 MASSACHUSETTS AVE NW STE 302
WASHINGTON DC
20016-4388
US

IV. Provider business mailing address

4910 MASSACHUSETTS AVE NW STE 302
WASHINGTON DC
20016-4388
US

V. Phone/Fax

Practice location:
  • Phone: 202-991-9000
  • Fax: 202-793-4900
Mailing address:
  • Phone: 202-841-3560
  • Fax: 866-215-8428

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207WX0200X
TaxonomyOphthalmic Plastic and Reconstructive Surgery Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. EMILY GERSON
Title or Position: PARTNER
Credential: MD
Phone: 202-841-3560