Provider Demographics
NPI:1063552669
Name:GOLDMAN, GARY D (DC)
Entity type:Individual
Prefix:DR
First Name:GARY
Middle Name:D
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9801 GEORGIA AVE
Mailing Address - Street 2:SUITE 2-26
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-5276
Mailing Address - Country:US
Mailing Address - Phone:301-593-1199
Mailing Address - Fax:301-593-0259
Practice Address - Street 1:9801 GEORGIA AVE
Practice Address - Street 2:SUITE 2-26
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20902-5276
Practice Address - Country:US
Practice Address - Phone:301-593-1199
Practice Address - Fax:301-593-0259
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDS01247111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor