| Montgomery Sports Medicine Center | |
|
11120 New Hampshire Ave Ste 411 Silver Spring MD 20904-2604 | |
| (301) 754-0505 | |
| (301) 754-0509 |
| Full Name | Montgomery Sports Medicine Center |
|---|---|
| Speciality | Family Medicine |
| Location | 11120 New Hampshire Ave, Silver Spring, Maryland |
| Authorized Official Name and Position | Eran Kessous (DIRECTOR) |
| Authorized Official Contact | 3017540505 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Montgomery Sports Medicine Center 11120 New Hampshire Ave Ste 411 Silver Spring MD 20904-2604 Ph: (301) 754-0505 | Montgomery Sports Medicine Center 11120 New Hampshire Ave Ste 411 Silver Spring MD 20904-2604 Ph: (301) 754-0505 |
| NPI Number | 1538392964 |
|---|---|
| Provider Enumeration Date | 09/02/2009 |
| Last Update Date | 10/09/2024 |
| Medicare PECOS PAC ID | 1658403316 |
|---|---|
| Medicare Enrollment ID | O20100715000200 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538392964 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207QS0010X | Family Medicine - Sports Medicine | D0066523 (Maryland) | Primary |
| Provider Name | Eran Kessous |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1821033358 PECOS PAC ID: 3274556329 Enrollment ID: I20100715000264 |
| Provider Name | Zafira Bhimani |
|---|---|
| Provider Type | Practitioner - Physical Therapist In Private Practice |
| Provider Identifiers | NPI Number: 1164956207 PECOS PAC ID: 6305117607 Enrollment ID: I20170804001372 |
| Provider Name | Jonathan D Lawless |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1053677518 PECOS PAC ID: 2961774617 Enrollment ID: I20170816000719 |
| Provider Name | Mohammad U Khubaib |
|---|---|
| Provider Type | Practitioner - Sports Medicine |
| Provider Identifiers | NPI Number: 1477084440 PECOS PAC ID: 3173941952 Enrollment ID: I20231213002042 |
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