Provider Demographics
NPI:1346233228
Name:GOLDNER, RONALD (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:
Last Name:GOLDNER
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 1:405 W REDWOOD ST
Mailing Address - Street 2:6TH FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21201-7005
Mailing Address - Country:US
Mailing Address - Phone:410-328-5766
Mailing Address - Fax:410-328-0098
Practice Address - Street 1:405 W REDWOOD ST
Practice Address - Street 2:6TH FLOOR
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21201-7005
Practice Address - Country:US
Practice Address - Phone:410-328-5766
Practice Address - Fax:410-328-0098
Is Sole Proprietor?:No
Enumeration Date:2005-08-25
Last Update Date:2008-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0003589207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
P00616041OtherRAILROAD MEDICARE PTAN
MD114311501Medicaid
MD32150001OtherCAREFIRST MARYLAND
DCS045-0011OtherBLUE SHIELD FEP
MD32150001OtherCAREFIRST MARYLAND
MDI043Medicare PIN