Physician Compare National (NPI:1174506620)

HEALTHCARE PROVIDER: KEN EVAN GOLDSTEIN D.P.M.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1174506620
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0840337887
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20091026000019
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	GOLDSTEIN
	Individual professional last name
Provider First Name	KEN
	Individual professional first name
Provider Middle Name	E
	Individual professional middle name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	TEMPLE UNIVERSITY SCHOOL OF PODIATRIC MEDICINE
	Individual professional's medical school
Graduation Year	1983
	Individual professional's medical school graduation year
Primary Specialty	PODIATRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	3700 JOSEPH SIEWICK DR
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 200
	Group Practice or individual's line 2 address
City	FAIRFAX
	Group Practice or individual's city
State	VA
	Group Practice or individual's state
Zip Code	220331737
	Group Practice or individual's zip code (9 digits when available)
Phone Number	7032640500
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Hospital Affiliation CCN 1	490023
	Medicare CCN of hospital where individual professional provides service 1
Hospital Affiliation LBN 1	FAUQUIER HOSPITAL
	Legal business name of hospital where individual professional provides service 1
Professional Accepts Medicare Assignment	Y