Provider Demographics
NPI:1346822244
Name:EMILY PORTER GERSON LLC
Entity Type:Organization
Organization Name:EMILY PORTER GERSON LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:PORTER
Authorized Official - Last Name:GERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-991-9000
Mailing Address - Street 1:4910 MASSACHUSETTS AVE NW STE 302
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-4388
Mailing Address - Country:US
Mailing Address - Phone:202-991-9000
Mailing Address - Fax:202-793-4900
Practice Address - Street 1:4910 MASSACHUSETTS AVE NW STE 302
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-4388
Practice Address - Country:US
Practice Address - Phone:202-991-9000
Practice Address - Fax:202-793-4900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDD61064OtherMEDICAL LICENSE