MEDICARE: EMILY PORTER GERSON LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	D61064	OTHER	MD	MEDICAL LICENSE

General Provider Information

NPI Number	:	1346822244
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMILY PORTER GERSON LLC

Provider Business Mailing Address
First Line	:	4910 MASSACHUSETTS AVE NW STE 302
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4388
Country	:	US
Telephone Number	:	202-991-9000
Fax Number	:	202-793-4900

Provider Business Practice Location Address
First Line	:	4910 MASSACHUSETTS AVE NW STE 302
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20016-4388
Country	:	US
Telephone Number	:	202-991-9000
Fax Number	:	202-793-4900

Authorized Official
Title or Position	:	OWNER
Name	:	DR. EMILY PORTER GERSON
Credential	:	MD
Telephone Number	:	202-991-9000

Provider Enumeration Date	:	04/21/2021
Last Update Date	:	04/21/2021

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Directions to “EMILY PORTER GERSON LLC ” Practice Location

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