Provider Demographics
NPI:1568697928
Name:GOICOCHEA, LINDSAY BLAKE (MD)
Entity Type:Individual
Prefix:
First Name:LINDSAY
Middle Name:BLAKE
Last Name:GOICOCHEA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 43130
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21236-0130
Mailing Address - Country:US
Mailing Address - Phone:410-931-0400
Mailing Address - Fax:410-931-1009
Practice Address - Street 1:6701 N CHARLES ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21204-6808
Practice Address - Country:US
Practice Address - Phone:443-849-2896
Practice Address - Fax:443-849-3016
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-28
Last Update Date:2018-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD75368207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD0670995000Medicaid