Provider Demographics
NPI:1447636048
Name:KESSOUS & KESSOUS MD PC
Entity type:Organization
Organization Name:KESSOUS & KESSOUS MD PC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/MD
Authorized Official - Prefix:DR
Authorized Official - First Name:EFRAIM
Authorized Official - Middle Name:
Authorized Official - Last Name:KESSOUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:732-768-8939
Mailing Address - Street 1:800 S FREDERICK AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4150
Mailing Address - Country:US
Mailing Address - Phone:732-768-8939
Mailing Address - Fax:301-498-1347
Practice Address - Street 1:800 S FREDERICK AVE
Practice Address - Street 2:STE 100
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4150
Practice Address - Country:US
Practice Address - Phone:732-768-8939
Practice Address - Fax:301-498-1347
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-05
Last Update Date:2023-07-05
Deactivation Date:2023-05-04
Deactivation Code:
Reactivation Date:2023-06-05
Provider Licenses
StateLicense IDTaxonomies
MDD0070798207R00000X
MDD0066523207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports MedicineGroup - Multi-Specialty