1629060504 NPI number — MICHAEL H GOLDMAN M.D.

Table of content: MICHAEL H GOLDMAN M.D. (NPI 1629060504)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629060504 NPI number — MICHAEL H GOLDMAN M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOLDMAN
Provider First Name:
MICHAEL
Provider Middle Name:
H
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1629060504
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8316 ARLINGTON BLVD
Provider Second Line Business Mailing Address:
STE 620
Provider Business Mailing Address City Name:
FAIRFAX
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22031-5204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-698-5556
Provider Business Mailing Address Fax Number:
703-807-0082

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8316 ARLINGTON BLVD
Provider Second Line Business Practice Location Address:
STE 620
Provider Business Practice Location Address City Name:
FAIRFAX
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22031-5204
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-698-5556
Provider Business Practice Location Address Fax Number:
703-807-0082
Provider Enumeration Date:
08/17/2005

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: 207RC0000X , with the licence number:  0101043150 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 54-1825253 . This is a "PHCS (PPO)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1825253 . This is a "TRICARE" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 1144 . This is a "CAREFIRST BCBS (VA/DC)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1825253 . This is a "GREAT WEST (PPO)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 832968 . This is a "FIRST HEALTH (PPO)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 010245001 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 428799 . This is a "NCPPO (PPO)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 428799 . This is a "UNITED HEALTHCARE/MAMSI" identifier , issued by the state of ( VI ) . This identifiers is of the category "OTHER".
  • Identifier: 6389467 . This is a "CIGNA PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 473766 . This is a "AETNA US HEALTHCARE PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1825253 . This is a "CCN/FIRST HEALTH (PPO)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 54-1825253 . This is a "UNITED HEALTHCARE HMO PPO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 4012492 . This is a "AETNA (HMO/POS)" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 523626-01 . This is a "CAREFIRST BCBS (MD)" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 203593 . This is a "ANTHEM BCBS PPO/HLTH HMO" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".




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