Healthcare Provider Details

I. General information

NPI: 1720247703
Provider Name (Legal Business Name): ELLEN RACHEL GOLDMARK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/05/2008
Last Update Date: 05/28/2025
Certification Date: 05/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 KEY WEST AVE. SUITE 420
ROCKVILLE MD
20850
US

IV. Provider business mailing address

10200 GRAND CENTRAL AVE STE 220
OWINGS MILLS MD
21117-4366
US

V. Phone/Fax

Practice location:
  • Phone: 301-258-1919
  • Fax: 301-258-9180
Mailing address:
  • Phone: 410-581-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208800000X
TaxonomyUrology Physician
License NumberD0077827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: