Provider Demographics
NPI:1699983858
Name:KESSOUS, EFRAIM (MD)
Entity type:Individual
Prefix:DR
First Name:EFRAIM
Middle Name:
Last Name:KESSOUS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 S FREDERICK AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4150
Mailing Address - Country:US
Mailing Address - Phone:301-208-2273
Mailing Address - Fax:240-252-4222
Practice Address - Street 1:800 S FREDERICK AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4150
Practice Address - Country:US
Practice Address - Phone:301-208-2273
Practice Address - Fax:240-252-4222
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-20
Last Update Date:2023-05-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DCMD040210207Q00000X
MDD0070798207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD18308ZDHLMedicare UPIN