Healthcare Provider Details

I. General information

NPI: 1922829712
Provider Name (Legal Business Name): ERAN KESSOUS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2024
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S FREDERICK AVE STE 110
GAITHERSBURG MD
20877-4151
US

IV. Provider business mailing address

11120 NEW HAMPSHIRE AVE STE 411
SILVER SPRING MD
20904-2620
US

V. Phone/Fax

Practice location:
  • Phone: 301-754-0505
  • Fax: 301-754-0509
Mailing address:
  • Phone: 301-754-0505
  • Fax: 301-754-0509

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: ERAN KESSOUS
Title or Position: OWNER
Credential: MD
Phone: 301-754-0505