MEDICARE: DR. GAIL R GOLDSTEIN M.D.

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	207N00000X	Dermatology Physician	D0056523	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1720076391
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GAIL R GOLDSTEIN M.D.

Provider Business Mailing Address
First Line	:	71 OLD MILL BOTTOM RD N
Second Line	:	SUITE 300
City	:	ANNAPOLIS
State	:	MD
Zip	:	21409-5431
Country	:	US
Telephone Number	:	410-268-3887
Fax Number	:	410-268-8171

Provider Business Practice Location Address
First Line	:	71 OLD MILL BOTTOM RD N
Second Line	:	SUITE 300
City	:	ANNAPOLIS
State	:	MD
Zip	:	21409-5431
Country	:	US
Telephone Number	:	410-268-3887
Fax Number	:	410-268-8171

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/07/2005
Last Update Date	:	03/25/2015

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