Provider Demographics
NPI:1417003286
Name:KRESS, DONALD W (MD, FACS)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:W
Last Name:KRESS
Suffix:
Gender:M
Credentials:MD, FACS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5388 STONE RD
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21703-6923
Mailing Address - Country:US
Mailing Address - Phone:301-698-2400
Mailing Address - Fax:301-698-2460
Practice Address - Street 1:1560 OPOSSUMTOWN PIKE
Practice Address - Street 2:SUITE A26
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4748
Practice Address - Country:US
Practice Address - Phone:301-698-2400
Practice Address - Fax:301-698-2460
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0037204174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDA72713Medicare UPIN