Provider Demographics
NPI:1619935665
Name:GOLDSTEIN, ELLIOT ROBERT (MD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:ROBERT
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 1:6000 EXECUTIVE BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-3803
Mailing Address - Country:US
Mailing Address - Phone:301-468-8999
Mailing Address - Fax:
Practice Address - Street 1:6000 EXECUTIVE BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-3803
Practice Address - Country:US
Practice Address - Phone:301-468-8999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2009-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0003581207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD3825808OtherCIGNA PROVIDER NUMBER
MD521186611OtherUNITED HEALTHCARE PROV #
MD8126841OtherMAMSI PROVIDER NUMBER
MD8126841OtherOPTIMUM CHOICE PROVIDER #
MD8126841OtherMDIPA PROVIDER NUMBER
MD026539OtherJHHC PROVIDER NUMBER
MD8126841OtherALLIANCE PROVIDER NUMBER
MD8126841OtherOPTIMUM CHOICE PROVIDER #
MDC88040Medicare UPIN