Provider Demographics
NPI:1821033358
Name:KESSOUS, ERAN (MD)
Entity Type:Individual
Prefix:
First Name:ERAN
Middle Name:
Last Name:KESSOUS
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 1:11120 NEW HAMPSHIRE AVE
Mailing Address - Street 2:SUITE 411
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-2633
Mailing Address - Country:US
Mailing Address - Phone:301-754-0505
Mailing Address - Fax:301-754-0509
Practice Address - Street 1:11120 NEW HAMPSHIRE AVE
Practice Address - Street 2:SUITE 411
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-2633
Practice Address - Country:US
Practice Address - Phone:301-754-0505
Practice Address - Fax:301-754-0509
Is Sole Proprietor?:No
Enumeration Date:2006-06-18
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MDD0066523207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
I47577Medicare UPIN