Provider Demographics
NPI:1437206984
Name:DAVID W. KOSSOFF, M.D., LLC
Entity Type:Organization
Organization Name:DAVID W. KOSSOFF, M.D., LLC
Other - Org Name:OPTIMAL DIGESTIVE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:G
Authorized Official - Last Name:FRENI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:855-427-8761
Mailing Address - Street 1:70 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 120
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4361
Mailing Address - Country:US
Mailing Address - Phone:301-624-5566
Mailing Address - Fax:301-624-5542
Practice Address - Street 1:70 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 120
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4361
Practice Address - Country:US
Practice Address - Phone:301-624-5566
Practice Address - Fax:301-624-5542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-05
Last Update Date:2022-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4040001OtherCAREFIRST NAT CAP AREA
MD494710OtherNCPPO
MD682BDAOtherCAREFRIST OF MD
MD376329OtherMDIPA OPT CHOICE
MDP10152OtherINFORMED
MDP00206418OtherRAILROAD MEDICARE
MD133102701Medicaid
MD682BDAOtherCAREFRIST OF MD
MD132NMedicare ID - Type Unspecified