Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | MD036863E | PA |
Y | 111NI0900X | Internist | MD036863E | PA |
N | 207RG0300X | Geriatric Medicine | MD036863E | PA |
NPI | 1134188964 |
---|---|
Provider Name | Kenneth D. Goldblum |
First Address | Exton, PA 19341-2500 |
Second Address | Coatesville, PA 19320-1572 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/03/2006 |
Last Update Date | 04/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
001127944 | (05) | PA |
B40995 | (02) | PA |