Provider Demographics
NPI:1396858072
Name:GOLDSTEIN, GUSTAVO ALBERTO (MD)
Entity Type:Individual
Prefix:
First Name:GUSTAVO
Middle Name:ALBERTO
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:GUSTAVO
Other - Middle Name:ALBERTO
Other - Last Name:GOLDSTEIN HERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:10808 SECLUDED WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-4335
Mailing Address - Country:US
Mailing Address - Phone:301-351-7492
Mailing Address - Fax:301-545-0195
Practice Address - Street 1:966 HUNGERFORD DR
Practice Address - Street 2:SUITE 14 B
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-1714
Practice Address - Country:US
Practice Address - Phone:301-351-7492
Practice Address - Fax:301-545-0195
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD414822084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry