Healthcare Provider Details

I. General information

NPI: 1962935841
Provider Name (Legal Business Name): ZACHARY KEROSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2017
Last Update Date: 02/02/2024
Certification Date: 02/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4954 N PALMER RD
BETHESDA MD
20889-5630
US

IV. Provider business mailing address

4954 N PALMER RD
BETHESDA MD
20889-5630
US

V. Phone/Fax

Practice location:
  • Phone: 301-295-4512
  • Fax: 301-295-4164
Mailing address:
  • Phone: 301-295-4512
  • Fax: 301-295-5164

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number2266
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207RR0500X
TaxonomyRheumatology Physician
License Number2266
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: