1154329118 NPI number — MR. HARLAN MATTHEW GOLDMAN D.C.

Table of content: MR. HARLAN MATTHEW GOLDMAN D.C. (NPI 1154329118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154329118 NPI number — MR. HARLAN MATTHEW GOLDMAN D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDMAN
Provider First Name:
HARLAN
Provider Middle Name:
MATTHEW
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154329118
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/11/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10475 PERRY HIGHWAY
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
WEXFORD
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15090
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
724-935-7440
Provider Business Mailing Address Fax Number:
724-934-4766

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8001 ROWAN RD
Provider Second Line Business Practice Location Address:
SUITE 216
Provider Business Practice Location Address City Name:
CRANBERRY TWP
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
16066
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
724-772-7440
Provider Business Practice Location Address Fax Number:
724-776-9399
Provider Enumeration Date:
07/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC8636 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NS0005X , with the licence number: DC8636 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: GO1310247 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30299 . This is a "UMPC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 11183316 . This is a "CAQH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2150317 . This is a "FIRST HEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7503594 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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