Provider Demographics
NPI:1780729210
Name:GOLDMAN, ROBERT LAWRENCE (MD)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:9420 KEY WEST AVE
Mailing Address - Street 2:#420
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:301-258-1919
Mailing Address - Fax:301-258-9180
Practice Address - Street 1:9420 KEY WEST AVE.
Practice Address - Street 2:#420
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850
Practice Address - Country:US
Practice Address - Phone:301-258-1919
Practice Address - Fax:301-258-9180
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD17969208800000X, 208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD962521600Medicaid
C61472Medicare UPIN
MD962521600Medicaid