Provider Demographics
NPI:1376659979
Name:GOLDSTEIN, KENNETH (MD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:
Last Name:GOLDSTEIN
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 1:6212 ROBINWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6115
Mailing Address - Country:US
Mailing Address - Phone:301-229-1798
Mailing Address - Fax:240-396-6421
Practice Address - Street 1:6212 ROBINWOOD RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6115
Practice Address - Country:US
Practice Address - Phone:301-229-1798
Practice Address - Fax:240-396-6421
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-23
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD017211174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC095668W38Medicare ID - Type Unspecified
DCB93331Medicare UPIN
DC1670-0001OtherCAREFIRST BCBS