Provider Demographics
NPI:1124012588
Name:GOLD, LEWIS FELDMAN (DO)
Entity Type:Individual
Prefix:
First Name:LEWIS
Middle Name:FELDMAN
Last Name:GOLD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17334
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21297-1334
Mailing Address - Country:US
Mailing Address - Phone:703-443-6717
Mailing Address - Fax:703-443-8643
Practice Address - Street 1:20955 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE 200
Practice Address - City:ASHBURN
Practice Address - State:VA
Practice Address - Zip Code:20147-3405
Practice Address - Country:US
Practice Address - Phone:703-729-7952
Practice Address - Fax:703-729-8746
Is Sole Proprietor?:No
Enumeration Date:2005-08-31
Last Update Date:2010-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0102049940208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA6705081Medicaid
VA6705081Medicaid
C61371Medicare UPIN