MEDICARE: DR. CRISTINA L GOLDIZEN MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2084P0800X	Psychiatry Physician	17694	WV

General Provider Information

NPI Number	:	1467553180
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CRISTINA L GOLDIZEN MD

Provider Business Mailing Address
First Line	:	99 CRACKER BARREL DR STE 100
Second Line	:
City	:	BARBOURSVILLE
State	:	WV
Zip	:	25504-1650
Country	:	US
Telephone Number	:	304-525-7851
Fax Number	:	304-257-4673

Provider Business Practice Location Address
First Line	:	55 DONOHOE DR
Second Line	:
City	:	HUNTINGTON
State	:	WV
Zip	:	25705-8887
Country	:	US
Telephone Number	:	304-525-7851
Fax Number	:	304-525-1073

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/26/2006
Last Update Date	:	09/18/2024

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