MEDICARE: GOLDMAN & PACKMAN

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	1223P0300X	Periodontics	4467	MD

General Provider Information

NPI Number	:	1255461760
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDMAN & PACKMAN

Provider Business Mailing Address
First Line	:	1205 DAIRY RD
Second Line	:
City	:	PARKTON
State	:	MD
Zip	:	21120-9505
Country	:	US
Telephone Number	:	410-329-6374
Fax Number	:

Provider Business Practice Location Address
First Line	:	7600 RITCHIE HWY
Second Line	:
City	:	GLEN BURNIE
State	:	MD
Zip	:	21061-3718
Country	:	US
Telephone Number	:	410-761-3335
Fax Number	:	410-761-3362

Authorized Official
Title or Position	:	PARTNER
Name	:	DR. STEPHEN A GOLDMAN
Credential	:	D.D.S.
Telephone Number	:	410-761-3335

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	08/22/2020

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