Provider Demographics
NPI:1427065382
Name:KRESSIN, BRIAN SAMUEL (DPM)
Entity type:Individual
Prefix:DR
First Name:BRIAN
Middle Name:SAMUEL
Last Name:KRESSIN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:DR
Other - First Name:BRIAN
Other - Middle Name:SAMUEL
Other - Last Name:KRESSIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DPM
Mailing Address - Street 1:15300 SPENCERVILLE CT
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BURTONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20866
Mailing Address - Country:US
Mailing Address - Phone:301-384-2629
Mailing Address - Fax:301-421-4286
Practice Address - Street 1:15300 SPENCERVILLE CT
Practice Address - Street 2:SUITE 101
Practice Address - City:BURTONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20866
Practice Address - Country:US
Practice Address - Phone:301-384-2629
Practice Address - Fax:301-421-4286
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-02
Last Update Date:2008-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00889213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
T30869Medicare UPIN
089537Medicare ID - Type Unspecified
0880830001Medicare NSC