Provider Demographics
NPI:1720076904
Name:ENGELSTEIN, JOEL M (MD)
Entity type:Individual
Prefix:
First Name:JOEL
Middle Name:M
Last Name:ENGELSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8630 FENTON ST
Mailing Address - Street 2:SUITE 130
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3806
Mailing Address - Country:US
Mailing Address - Phone:301-588-1177
Mailing Address - Fax:301-589-5245
Practice Address - Street 1:8630 FENTON ST
Practice Address - Street 2:SUITE 130
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3806
Practice Address - Country:US
Practice Address - Phone:301-588-1177
Practice Address - Fax:301-589-5245
Is Sole Proprietor?:No
Enumeration Date:2005-10-11
Last Update Date:2007-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD19187207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDB93174Medicare UPIN
MD075964R08Medicare PIN