MEDICARE: DR. KEN EVAN GOLDSTEIN D.P.M.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213ES0103X	Foot & Ankle Surgery Podiatrist	0103000671	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1174506620
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEN EVAN GOLDSTEIN D.P.M.

Provider Business Mailing Address
First Line	:	400D HOSPITAL DR
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-3026
Country	:	US
Telephone Number	:	540-347-9393
Fax Number	:	540-347-9398

Provider Business Practice Location Address
First Line	:	400D HOSPITAL DR
Second Line	:
City	:	WARRENTON
State	:	VA
Zip	:	20186-3026
Country	:	US
Telephone Number	:	540-347-9393
Fax Number	:	540-347-9398

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/29/2005
Last Update Date	:	09/30/2008

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