Provider Demographics
NPI:1174794507
Name:BRIAN S. KRESSIN
Entity type:Organization
Organization Name:BRIAN S. KRESSIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:KRESSIN
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:301-384-2629
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:20866-1653
Mailing Address - Country:US
Mailing Address - Phone:301-421-4286
Mailing Address - Fax:
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:20866-1653
Practice Address - Country:US
Practice Address - Phone:301-421-4286
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-13
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00889213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0880830001Medicare NSC