Healthcare Provider Details

I. General information

NPI: 1437206984
Provider Name (Legal Business Name): DAVID W. KOSSOFF, M.D., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2007
Last Update Date: 05/19/2025
Certification Date: 05/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 THOMAS JOHNSON DR STE 335
FREDERICK MD
21702-4949
US

IV. Provider business mailing address

110 THOMAS JOHNSON DR STE 335
FREDERICK MD
21702-4949
US

V. Phone/Fax

Practice location:
  • Phone: 301-624-5566
  • Fax: 301-624-5542
Mailing address:
  • Phone: 301-624-5566
  • Fax: 301-624-5542

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberD0054121
License Number StateMD

VIII. Authorized Official

Name: ALAN OLIVER
Title or Position: CEO
Credential:
Phone: 786-530-3820