Provider Demographics
NPI:1164488300
Name:ELLIOT R GOLDSTEIN MD & JOEL R SCHULMAN MD PA
Entity Type:Organization
Organization Name:ELLIOT R GOLDSTEIN MD & JOEL R SCHULMAN MD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:
Authorized Official - Last Name:WEISEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-207-2030
Mailing Address - Street 1:6010 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3809
Mailing Address - Country:US
Mailing Address - Phone:240-207-2030
Mailing Address - Fax:301-468-0614
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:301-468-8999
Practice Address - Fax:301-468-0614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-25
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207N00000X, 207R00000X, 207VX0201X, 207X00000X, 208800000X, 213E00000X
MD207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD832407OtherMDIPA GROUP #
V746OtherBCBS
MD832407OtherOPTIMUM CHOICE GROUP #
V746OtherBCBS
MD832407OtherOPTIMUM CHOICE GROUP #
V746OtherBCBS
MD410178Medicare PIN