Provider Demographics
NPI:1184710931
Name:GOLDSTEIN, GERALD (MD)
Entity type:Individual
Prefix:DR
First Name:GERALD
Middle Name:
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 1:500 MEMORIAL AVE
Mailing Address - Street 2:SUITE 307
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3732
Mailing Address - Country:US
Mailing Address - Phone:301-723-4965
Mailing Address - Fax:
Practice Address - Street 1:500 MEMORIAL AVE
Practice Address - Street 2:SUITE 307
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3732
Practice Address - Country:US
Practice Address - Phone:301-723-4965
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0022972207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC88571Medicare UPIN
MDS516C069Medicare ID - Type Unspecified