Provider Demographics
NPI:1629152582
Name:KOSSOFF, DAVID W (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:W
Last Name:KOSSOFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 THOMAS JOHNSON DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4599
Mailing Address - Country:US
Mailing Address - Phone:301-624-5566
Mailing Address - Fax:301-624-5542
Practice Address - Street 1:56 THOMAS JOHNSON DR
Practice Address - Street 2:SUITE 110
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4599
Practice Address - Country:US
Practice Address - Phone:301-624-5566
Practice Address - Fax:301-624-5542
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-25
Last Update Date:2012-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0054121174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP10152OtherINFORMED
MD376329OtherALLIANCE MAMSI
MDP00206418OtherRAILROAD MEDICARE
MD494710OtherNCPPO
MD682BDAOtherCAREFIRST OF MARYLAND
DCK4040001OtherCAREFIRST OF NATIONAL CAP
MD133102701Medicaid
MD2027119OtherUNITED HEALTHCARE
MD682BDAOtherCAREFIRST OF MARYLAND
MD376329OtherALLIANCE MAMSI