Provider Demographics
NPI:1649216342
Name:GOLDSTEIN, MARK G (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:G
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:PO BOX 749495
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-9495
Mailing Address - Country:US
Mailing Address - Phone:239-432-8331
Mailing Address - Fax:813-321-1296
Practice Address - Street 1:19735 GERMANTOWN RD STE 255
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-1219
Practice Address - Country:US
Practice Address - Phone:301-571-0019
Practice Address - Fax:301-530-2515
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-02-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CT043952207R00000X
PAMD438212207RH0003X
MDD67691207RX0202X
MDD0067691207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD418915900Medicaid