Provider Demographics
NPI:1649281122
Name:GERSON, EMILY PORTER (MD)
Entity type:Individual
Prefix:DR
First Name:EMILY
Middle Name:PORTER
Last Name:GERSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4910 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
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD61064207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCMD034213OtherDC MD LICENSE
DC1F1388OtherPTAN