Healthcare Provider Details

I. General information

NPI: 1821033358
Provider Name (Legal Business Name): ERAN KESSOUS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2006
Last Update Date: 10/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11120 NEW HAMPSHIRE AVE SUITE 411
SILVER SPRING MD
20904-2633
US

IV. Provider business mailing address

11120 NEW HAMPSHIRE AVE SUITE 411
SILVER SPRING MD
20904-2633
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 Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberD0066523
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: