Provider Demographics
NPI:1376015560
Name:GOLDENBERG, RONALD
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:
Last Name:GOLDENBERG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10901 TROTTING RIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2817
Mailing Address - Country:US
Mailing Address - Phone:443-834-5034
Mailing Address - Fax:
Practice Address - Street 1:710 OBRECHT RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-7650
Practice Address - Country:US
Practice Address - Phone:410-795-8808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-28
Last Update Date:2018-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDA3287225200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225200000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapy Assistant