Provider Demographics
NPI:1689035255
Name:GOLDSTROM, KELSEY HANNAH (PA-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:HANNAH
Last Name:GOLDSTROM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:438 FIVE FARMS LN
Mailing Address - Street 2:
Mailing Address - City:TIMONIUM
Mailing Address - State:MD
Mailing Address - Zip Code:21093-2955
Mailing Address - Country:US
Mailing Address - Phone:410-952-2554
Mailing Address - Fax:
Practice Address - Street 1:438 FIVE FARMS LN
Practice Address - Street 2:
Practice Address - City:TIMONIUM
Practice Address - State:MD
Practice Address - Zip Code:21093-2955
Practice Address - Country:US
Practice Address - Phone:410-952-2554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant