Provider Demographics
NPI:1780794578
Name:GOLDSTEIN, ALBEN G (MD)
Entity type:Individual
Prefix:
First Name:ALBEN
Middle Name:G
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 S CARLIN SPRINGS ROAD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22204
Mailing Address - Country:US
Mailing Address - Phone:703-379-5828
Mailing Address - Fax:703-379-5827
Practice Address - Street 1:611 S CARLIN SPRINGS ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204
Practice Address - Country:US
Practice Address - Phone:703-379-5828
Practice Address - Fax:703-379-5827
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101028331207RR0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
80340001OtherBC/BS DC
000055A24Medicare ID - Type Unspecified
D17954Medicare UPIN