Healthcare Provider Details

I. General information

NPI: 1447636048
Provider Name (Legal Business Name): KESSOUS & KESSOUS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/05/2015
Last Update Date: 07/05/2023
Certification Date: 07/05/2023
Deactivation Date: 05/04/2023
Reactivation Date: 06/05/2023

III. Provider practice location address

800 S FREDERICK AVE STE 100
GAITHERSBURG MD
20877-4150
US

IV. Provider business mailing address

800 S FREDERICK AVE STE 100
GAITHERSBURG MD
20877-4150
US

V. Phone/Fax

Practice location:
  • Phone: 732-768-8939
  • Fax: 301-498-1347
Mailing address:
  • Phone: 732-768-8939
  • Fax: 301-498-1347

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207XX0005X
TaxonomySports Medicine (Orthopaedic Surgery) Physician
License NumberD0066523
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberD0070798
License Number StateMD

VIII. Authorized Official

Name: DR. EFRAIM KESSOUS
Title or Position: OWNER/MD
Credential: MD
Phone: 732-768-8939