Individual
KENNETH D. GOLDBLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
217 REECEVILLE RD, SUITE C, COATESVILLE, PA 19320-1572
(610) 384-5110
(610) 594-2625
Mailing address
412 CREAMERY WAY, SUITE 400, EXTON, PA 19341-2500
(610) 384-5110
(610) 594-2625
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD036863E
PA
207RG0300X
Geriatric Medicine (Internal Medicine) Physician
MD036863E
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
001127944
—
PA
Enumeration date
03/21/2006
Last updated
12/04/2013
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