Provider Demographics
NPI:1720217508
Name:MICHAEL G. GOLDER, MD, PLLC
Entity Type:Organization
Organization Name:MICHAEL G. GOLDER, MD, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:202-379-4650
Mailing Address - Street 1:5335 WISCONSIN AVE NW
Mailing Address - Street 2:STE 440
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2030
Mailing Address - Country:US
Mailing Address - Phone:202-379-4650
Mailing Address - Fax:
Practice Address - Street 1:5335 WISCONSIN AVE NW
Practice Address - Street 2:STE 440
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2030
Practice Address - Country:US
Practice Address - Phone:202-379-4650
Practice Address - Fax:202-370-7173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-14
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC21471261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health