Healthcare Provider Details

I. General information

NPI: 1164579348
Provider Name (Legal Business Name): PRISCILLA GOLDIE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2007
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3020 14TH ST NW
WASHINGTON DC
20009-6865
US

IV. Provider business mailing address

40 PATTERSON ST NE
WASHINGTON DC
20002-3334
US

V. Phone/Fax

Practice location:
  • Phone: 202-745-4300
  • Fax: 202-299-1755
Mailing address:
  • Phone: 202-354-1120
  • Fax: 202-478-0609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD33660
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: