Individual
ELLIE P GOLDBLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
21 CROSSROADS DR, SUITE 400, OWINGS MILLS, MD 21117-5441
(410) 998-9100
(410) 998-9104
Mailing address
21 CROSSROADS DR, SUITE 400, OWINGS MILLS, MD 21117-5441
(410) 998-9100
(410) 998-9104
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
D0053968
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
654003100
—
MD
01
—
C31152
R/R MEDICARE GROUP PIN
MD
01
—
P00759902
R/R MEDICARE PIN
MD
Enumeration date
12/15/2005
Last updated
04/16/2010
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