Provider Demographics
NPI:1275564593
Name:GOLDBAUM, THOMAS SPENCER (MD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SPENCER
Last Name:GOLDBAUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5530 WISCONSIN AVE
Mailing Address - Street 2:SUITE 515
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4404
Mailing Address - Country:US
Mailing Address - Phone:301-656-4064
Mailing Address - Fax:410-367-2069
Practice Address - Street 1:5530 WISCONSIN AVE
Practice Address - Street 2:SUITE 515
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-4404
Practice Address - Country:US
Practice Address - Phone:301-656-4064
Practice Address - Fax:410-367-2069
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0030885174400000X
MDMD-30885207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32331400Medicaid
MD103252OtherMEDICARE
MD32331400Medicaid
MD420231B52Medicare PIN