Provider Demographics
NPI:1932102357
Name:GOLDSTEIN, MARK A (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1838 GREENE TREE RD
Mailing Address - Street 2:SUITE 150
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208
Mailing Address - Country:US
Mailing Address - Phone:410-602-9262
Mailing Address - Fax:410-602-9276
Practice Address - Street 1:7505 OSLER DR
Practice Address - Street 2:STE 103
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7737
Practice Address - Country:US
Practice Address - Phone:410-583-1170
Practice Address - Fax:410-583-1267
Is Sole Proprietor?:No
Enumeration Date:2005-05-31
Last Update Date:2010-08-31
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MDD0036639207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD287241200Medicaid
MD287241200Medicaid
MD000L799XMedicare ID - Type Unspecified
F30877Medicare UPIN