1255456299 NPI number — EDWARD J. GOLDMAN, M.D.,P.A.

Table of content: (NPI 1255456299)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255456299 NPI number — EDWARD J. GOLDMAN, M.D.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EDWARD J. GOLDMAN, M.D.,P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1255456299
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
25 CROSSROADS DR
Provider Second Line Business Mailing Address:
SUITE 412
Provider Business Mailing Address City Name:
OWINGS MILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21117-5439
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
443-394-6400
Provider Business Mailing Address Fax Number:
443-394-9850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
25 CROSSROADS DRIVE
Provider Second Line Business Practice Location Address:
SUITE 412
Provider Business Practice Location Address City Name:
OWINGS MILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21117-5439
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
443-394-6400
Provider Business Practice Location Address Fax Number:
443-394-9850
Provider Enumeration Date:
03/20/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GOLDMAN
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
JAY
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
443-394-6400

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  D76229 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X , with the licence number: D30288 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 760010100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 760010100MD , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: KA47 . This is a "CAREFIRST" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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