Provider Demographics
NPI:1528193364
Name:GOLDSTEIN, DEBORAH LOIS (PT)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:LOIS
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9110 PHILADELPHIA RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-4301
Mailing Address - Country:US
Mailing Address - Phone:410-686-8922
Mailing Address - Fax:
Practice Address - Street 1:9110 PHILADELPHIA RD
Practice Address - Street 2:SUITE 104
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-4301
Practice Address - Country:US
Practice Address - Phone:410-686-8922
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2012-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15153225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD52792505OtherBLUE CROSS BLUE SHIELD
MDS9550002OtherBCBS FEDERAL
MDDA2862 P00046849OtherRAILROAD MEDICARE
MD928L80VVMedicare ID - Type Unspecified
MDS00423Medicare UPIN