Provider Demographics
NPI:1508946187
Name:GOLDWASSER, JOEL JAY (DC)
Entity Type:Individual
Prefix:DR
First Name:JOEL
Middle Name:JAY
Last Name:GOLDWASSER
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3406 BIRCH HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-1839
Mailing Address - Country:US
Mailing Address - Phone:410-484-6718
Mailing Address - Fax:
Practice Address - Street 1:9403 HARFORD RD
Practice Address - Street 2:SUITE 1
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-3123
Practice Address - Country:US
Practice Address - Phone:410-882-0720
Practice Address - Fax:410-882-6767
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01148111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD32162001OtherBLUECROSS/BLUESHIELD
MDT59563Medicare UPIN
MD752M307FMedicare ID - Type Unspecified