Healthcare Provider Details

I. General information

NPI: 1316996044
Provider Name (Legal Business Name): STUART M GOLDMAN D.P.M.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 OLD COURT RD SUITE 301
BALTIMORE MD
21208
US

IV. Provider business mailing address

4000 OLD COURT RD STE 301
PIKESVILLE MD
21208-6417
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-2345
  • Fax:
Mailing address:
  • Phone: 410-235-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberPO0001483
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number01444
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: