Provider Demographics
NPI:1316996044
Name:GOLDMAN, STUART M (DPM)
Entity type:Individual
Prefix:DR
First Name:STUART
Middle Name:M
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4000 OLD COURT RD STE 301
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6417
Mailing Address - Country:US
Mailing Address - Phone:410-235-2345
Mailing Address - Fax:
Practice Address - Street 1:4000 OLD COURT RD
Practice Address - Street 2:SUITE 301
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208
Practice Address - Country:US
Practice Address - Phone:410-235-2345
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2018-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO0001483213ES0103X
MD01444213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL87694OtherBC/BS
FL87694AMedicare ID - Type Unspecified
FL87694OtherBC/BS
FLT55505Medicare UPIN