MEDICARE: MARSHALL R GOLDMAN DDSPA

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	1223G0001X	General Practice Dentistry	3686	MD

General Provider Information

NPI Number	:	1669686150
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MARSHALL R GOLDMAN DDSPA

Provider Business Mailing Address
First Line	:	2430 DIANA RD
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21209-1526
Country	:	US
Telephone Number	:	410-486-2158
Fax Number	:

Provider Business Practice Location Address
First Line	:	11963 REISTERSTOWN RD
Second Line	:
City	:	REISTERSTOWN
State	:	MD
Zip	:	21136-3030
Country	:	US
Telephone Number	:	410-833-6200
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. MARSHALL ROBERT GOLDMAN
Credential	:
Telephone Number	:	410-486-2158

Provider Enumeration Date	:	05/10/2007
Last Update Date	:	08/22/2020

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