MEDICARE: GERSON ZATEZALO SKIN & FACE

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	207W00000X	Ophthalmology Physician
2	207WX0200X	Ophthalmic Plastic and Reconstructive Surgery Physician
3	207N00000X	Dermatology Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1F1388	OTHER	DC	PTAN

General Provider Information

NPI Number	:	1588272397
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERSON ZATEZALO SKIN & FACE

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	:	202-841-3560
Fax Number	:	866-215-8428

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	:	PARTNER
Name	:	DR. EMILY GERSON
Credential	:	MD
Telephone Number	:	202-841-3560

Provider Enumeration Date	:	07/17/2020
Last Update Date	:	09/23/2020

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