Provider Demographics
NPI:1023159472
Name:GOLDMARK, MARCIA P (MD)
Entity type:Individual
Prefix:DR
First Name:MARCIA
Middle Name:P
Last Name:GOLDMARK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4823 HORNBEAM DR
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20853-1422
Mailing Address - Country:US
Mailing Address - Phone:301-924-1109
Mailing Address - Fax:
Practice Address - Street 1:15020 SHADY GROVE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3364
Practice Address - Country:US
Practice Address - Phone:301-545-1811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD0025348174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC88974Medicare UPIN