Healthcare Provider Details

I. General information

NPI: 1104282409
Provider Name (Legal Business Name): ERAN KESSOUS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2016
Last Update Date: 01/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

11120 NEW HAMPSHIRE AVE 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 Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberD0066523
License Number StateMD

VIII. Authorized Official

Name: MS. DONA MARIA BOWIE
Title or Position: OFFICE MANAGER
Credential:
Phone: 301-754-0505