MEDICARE: SARAH ANN CHAMBERS GURSON M.D.

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	208000000X	Pediatrics Physician	240674	NY
2	2080P0202X	Pediatric Cardiology Physician	0101259229	VA

General Provider Information

NPI Number	:	1518018076
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SARAH ANN CHAMBERS GURSON M.D.

Provider Business Mailing Address
First Line	:	PO BOX 37174
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21297-3174
Country	:	US
Telephone Number	:	714-235-6995
Fax Number	:	571-423-5698

Provider Business Practice Location Address
First Line	:	8500 EXECUTIVE PARK AVE STE 110
Second Line	:
City	:	FAIRFAX
State	:	VA
Zip	:	22031-2228
Country	:	US
Telephone Number	:	703-573-0504
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/12/2007
Last Update Date	:	04/27/2022

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